Search

Item does not contain fulltext This article explores how probation officers (POs) in France employ evidence-based practice in the real world. Using 78 audio tapes of 11 POs and 33 offenders in 2 probations services, we assessed PO skills with an adapted version of the Jersey Checklist. Our results suggest that French probation officers generally possess good communication skills, and use – to a certain extent – core correctional practices. They do, however, underperform with regard to cognitive behavioural techniques. 21 p.

Item does not contain fulltext This study seeks to add to the existing knowledge and available literature on schema therapy elements in forensic inpatient samples. Early maladaptive schemas and emotional states were assessed in Dutch individuals with sexual convictions and compared to individuals with nonsexual violent convictions. Self-ratings of the Young Schema Questionnaire and the Schema Mode Inventory of 95 patients with either convictions for child sexual abuse (N = 30), sexual violence against adults (N = 34), and nonsexual violent convictions (N = 31) were examined using one-way multivariate ANOVAs. Regardless of victim type, forensic patients convicted for sexual offending, and patients with convictions for nonsexual violent offending, seem to make equal use of specific maladaptive cognitive schemas and schema modes during mandated inpatient care. Other studies have shown that people with sexual offense histories are typically characterized by insecure attachment, overvigilance towards women, or a child-like self-concept. Our study indicates that forensic patient in Dutch mandated care may be qualitatively different from typical patients with sexual offense histories and that Dutch patients with violent or sexual offense histories are more similar than they are dissimilar. 21 maart 2023 18 p.

BackgroundViolent criminal offenders with personality disorders (PD's) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs.MethodsWe compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise-specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms.ResultsPatients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes – rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms – and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*time: t(1387) = −2.85, p = 0.005).ConclusionsThese findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community.

Item does not contain fulltext Therapy alliance has been studied largely in voluntary psychotherapy but less is known about its predictive factors for positive alliance and treatment outcome in forensic populations. The aim of this study was to examine the relationship between offenders' emotional states and therapy alliance. Moreover, we were interested in the predictive impact of emotional states early in treatment on alliance at 18 months into treatment. Self-ratings of emotional states and alliance by 103 male offenders, and therapist-ratings for therapy alliance were examined using hierarchical multiple regression analyses. Participants were primarily convicted for violent of sexual offenses, and were diagnosed with antisocial, borderline or narcissistic personality disorders. Healthy emotional states were predictive of mid-treatment agreement on therapy goals and therapist ratings on tasks within the therapy. Unhealthy emotional states were predictive of patient-rated agreement on tasks. Emotional states were not predictive for the reported therapist/patient bond or global alliance ratings. This study emphasizes the importance of healthy emotional states in treatment of offenders with personality disorders. 20 p.

Item does not contain fulltext The aim of this study was to examine the emotional states preceding and during sexual and violent offenses in a Dutch sample of male forensic inpatients. Moreover, the predictive impact of these emotional states on institutional violence in the first year of mandated care was examined using an incident scheme. Observer-ratings of emotional states by 103 male offenders and 97 sex offenders were examined using Mann-Whitney U tests. Using hierarchical multiple regression analyses, the predictive relationship between crime-related emotional states and incidents was examined. Sexual and violent crimes were equally preceded by painful emotions, primarily feelings of abandonment. During violent crimes, a state of bully and attack was dominant whereas sexual crimes were also characterized by self-aggrandizement and manipulation. These emotional states were not predictive for institutional violence. This study emphasizes the importance of emotional states in offending behavior and usefulness of schema therapy’s crime theory. 08 juli 2022 18 p.

Contains fulltext : 285173.pdf (Publisher’s version ) (Closed access) Insomnia has a negative impact on mental health and is a potential risk factor for impulsive and problematic behavior. This multicenter, cross-sectional study investigated the prevalence of insomnia and underlying and maintaining factors in a group of forensic psychiatric inpatients (N = 281). Insomnia severity, subjective sleep quality, sleep hygiene and erroneous cognitions about sleep were measured with the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Sleep Hygiene questionnaire and Dysfunctional Beliefs and Attitudes about Sleep, respectively. Impulsivity was derived from risk assessment instruments routinely completed by trained professionals. Almost half of the patients (48.7%) appeared to suffer from insomnia. Particularly moderate-severe insomnia (26.7%) was significantly associated with worse sleep quality, poorer sleep hygiene, stronger endorsement of dysfunctional sleep cognitions and higher impulsivity scores. It can be concluded that insomnia is rather common in forensic psychiatric patients. Insomnia appears related to various sleep hygiene behaviors and sleep-related cognitions, and probably also to diverse situational and environmental factors as well as a lack of autonomy. Cognitive behavioral therapy for insomnia, with some adjustments specific for this population, may be an effective intervention, ameliorating sleep problems and possibly also emotional and behavioral dysregulation. 19 p.

Item does not contain fulltext Although there is an increasing focus on therapy alliance and its predictive factors, there has been limited exploration of these predictive factors within forensic services. Adverse childhood experiences (ACEs) could be one of these possible factors. In the present study, we examined whether ACEs are predictive for therapy alliance in male inpatients with cluster B personality disorders who are convicted for a violent offense. We were specifically interested in the predictive value of ACEs on therapy alliance at 18 months into treatment, and whether personality pathology mediates this relationship. ACEs, self-rated and observer-rated therapy alliance, and personality pathology were assessed within 103 male offenders and analyzed using hierarchical multiple regression analyses, and mediation analyses using PROCESS. Results show that self-rated agreement on therapy tasks was predicted by emotional neglect, whereas observer-rated agreement on therapy tasks was predicted by physical neglect. Physical, sexual, and emotional abuse were not predictive for therapy alliance. Personality disorders were no mediating factors. Despite limitations, this study emphasizes the importance of childhood neglect in treatment of male inpatients with convictions for violent offenses and contributes to our understanding of the concept of therapy alliance in people with convictions. 22 p.

Item does not contain fulltext Background: Patients with an intellectual disability (ID) and offending histories constitute a challenging clinical group. The present study examined commonalities and differences in demographic, diagnostic and offence characteristics in patients with and without intellectual disabilities who were either convicted for violent or sexual offences and who resided in mandated care in the Netherlands. Method: We compared 165 offenders with an ID to 249 offenders without an ID. We compared both groups by type of offence (i.e., sexual versus violent offence) using Mann–Whitney U-test or independent samples t-tests for continuous variables and Chi-square tests for categorical variables. Results: In general, forensic patients with an ID were younger at admission (U=357, z = -12.668, p

Item does not contain fulltext The purpose of this study is to assess treatment change at both a group and individual level in a sample of 81 Dutch male patients who received mandated care for either violent (non-sexual) behavior or sexual violent behavior. Psychiatric nurses rated patients' social skills, insight, hostility, physical violence with the BEST-Index every 6 months over the course of 2 years after patients were admitted to hospital. Mixed analysis of covariances and the reliable change index indicated that patients, irrespective of offense type, showed treatment change over time with exception of physical violence. This study shows that general treatment may be useful in the first 18 month for risk factors common to different types of offenses, but that specialized treatment is needed to establish further change. 18 p.

Item does not contain fulltext There is little evidence on the effectiveness of arts therapy interventions in forensic settings. The aim of this study was to explore the effects of arts therapy in evoking emotional vulnerability in forensic patients. Participants received drama, art or psychomotor therapy. For each therapy, we used a 5-session protocol that consisted of an introduction session, an assessment session, an intervention session that deliberately aimed to evoke emotional vulnerability, a regular intervention session, and a wrap-up session. Emotional vulnerability was assessed with the Mode Observation Scale and the Schema Mode Inventory, which is a self-report. Participants showed a significant increase in emotional vulnerability in both intervention sessions. The self-report ratings indicated that there was no significant change in vulnerable emotions. Our hypothesis was only partially supported. The findings provide some support for the effectiveness of arts therapy interventions in forensic patients. 9 p.

Purpose Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders. Design/methodology/approach The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates. Findings Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant. Practical implications These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders. Originality/value The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders.

Contains fulltext : 221358.pdf (Publisher’s version ) (Open Access) Many forensic psychiatric inpatients have difficulties regulating aggressive behavior. Evidence of effective aggression treatments is limited. We designed and investigated the effectiveness of a transdiagnostic application of a virtual reality aggression prevention training (VRAPT). In this randomized controlled trial at four Dutch forensic psychiatric centers, 128 inpatients with aggressive behavior were randomly assigned to VRAPT (N = 64) or waiting list control group (N = 64). VRAPT consisted of 16 one-hour individual treatment sessions twice a week. Assessments were done at baseline, post-treatment and at 3-month follow-up. Primary outcome measures were aggressive behavior observed by staff and self-reported aggressive behavior. Analysis was by intention to treat. This trial was registered in the Dutch Trial Register (NTR, TC = 6340). Participants were included between 1 March 2017, and 31 December 2018. Compared to waiting list, VRAPT did not significantly decrease in self-reported or observed aggressive behavior (primary outcomes). Hostility, anger control, and non-planning impulsiveness improved significantly in the VRAPT group compared to the control group at post-treatment. Improvements were not maintained at 3-month follow-up. Results suggest that VRAPT does not decrease aggressive behavior in forensic inpatients. However, there are indications that VRAPT temporarily influences anger control skills, impulsivity and hostility. 18 p.

In the last few decades, the forensic literature has been dominated by violence risk and instruments that assess risk for violent and criminal behavior. Typically, these instruments are guided by the theoretical risk-need-responsivity model. According to this model, criminogenic needs are the cornerstone for forensic treatment. Criminogenic and general needs, such as mental health, quality of life, and social factors, are important for care planning in offenders because unmet needs can have significant implications for offenders’ future violence risk. However, needs assessment in forensic mental health services is still underdeveloped when compared to the long tradition of needs assessment in general psychiatric mental health services. Recently, internationally validated instruments that measure needs in psychiatric populations, such as the Camberwell Assessment of Need (CAN), Health of the Nations Outcome Scales (HoNOS), and international Resident Assessment Instrument (interRAI) have been adapte...

Het werk met zedenplegers lijkt een belangrijke impact te hebben op het welzijn van de betrokken professionals. Het is echter opvallend dat er zowel in de praktijk als in de literatuur nog relatief weinig aandacht naartoe gaat. Daar wil de Nederlands-Vlaamse tak van ATSA (NL-ATSA) verandering in brengen. NL-ATSA richt zich op de preventie van seksueel geweld en op de behandeling van zedenplegers. Om de impact van het werken met zedenplegers meer onder de aandacht te brengen organiseerde de vereniging recentelijk een symposium. Vier sprekers werden hiervoor uitgenodigd. Zij bespraken onder andere de mentale weerbaarheid en copingstrategieën van kinderpornorechercheurs, de prevalentie en ernst van (seksuele) agressieve incidenten in een tbs-kliniek, hoe collega’s elkaar kunnen steunen na een incident met een cliënt en hoe je als professional grensoverschrijdend gedrag vanuit de cliënt kunt halt houden. In dit artikel wordt verslag gedaan van deze dag om het onderwerp meer onder de aandacht te brengen.

PurposeA core element of Schema Therapy (ST) is schema modes' or fluctuating emotional states. ST assumes that particular personality pathology consists of specific combinations of maladaptive schema modes. There is confirmatory evidence for the modes hypothesized to be central to borderline and narcissistic personality disorder (PD) in non-forensic patients. In this study, we tested three aspects of the construct validity of schema modes in cluster-B personality disordered offenders, examining its factorial validity, and the relations among personality disorders and violence risk.MethodOur sample consisted of 70 offenders who were diagnosed with an antisocial, borderline, or narcissistic PD. Schema modes were assessed with the Schema Mode Inventory (SMI), personality disorders with the Schedule for Nonadaptive and Adaptive Personality-Forensic Version (SNAP-FV), and violence risk with the Historical, Clinical, and Risk management scheme (HCR-20(V2)).ResultsWhen controlling for the two other PDs, three schema mode factors distinguished antisocial PD as a disorder involving both low scores on internalizing and high scores on externalizing modes, and borderline PD as involving high scores on internalizing modes. Furthermore, the externalizing schema modes were a significant predictor for violence risk inside the hospital.ConclusionsThe hypothesized mode models were partially supported for all three PDs. The findings thus provide some support for the construct validity of schema modes in a forensic sample.

Offenders with personality disorders (PDs) and the crimes that they have committed are regularly associated with emotional deficits. A renewed focus in forensic treatment is the use of experiential techniques: techniques that have a strong focus on eliciting emotions. However, there is little empirical evidence on the effectiveness of experiential techniques in forensic clients with PDs. In our pilot study, we examined whether three experiential drama therapy interventions are effective in evoking emotional vulnerability and anger in nine offenders with cluster B PDs, that is, clients with DSM-IV Antisocial, Borderline, or Narcissistic PDs. We used a 5 session drama therapy protocol that consisted of an introduction session, a general experiential session, a session to evoke emotional vulnerability, a session to evoke anger, and a wrap-up session. Emotions were assessed using the Mode Observation Scale. Participants showed significantly more emotional vulnerability within all three experiential invention sessions, comparing peak mood after the experiential intervention was initiated to baseline mood. In contrast, clients did not show more anger after the session to evoke anger, or in the other two experiential sessions. Our findings, though preliminary, suggest that experiential drama therapy methods may be effective in evoking vulnerable emotional states in forensic clients with cluster B personality disorders. We discuss the clinical implications of these findings.

According to Dutch Law, patients committing severe crimes justifying imprisonment of four years or more who cannot be held (fully) accountable for these acts can be sentenced to compulsory hospitalization in a specialized TBS hospital in the Netherlands. In the current paper, the effects of TBS treatment will be addressed in terms of recidivism numbers after termination of TBS treatment, as well as in behavioral changes that are observed during admission to TBS hospitals. Although these results offer some indirect support suggesting that TBS is effective, no randomized controlled trials had been conducted up until now that could confirm this. In the current study, preliminary results are reported from a multicenter randomized clinical trial on the effectiveness of Schema Therapy (ST) for hospitalized TBS patients with Antisocial, Borderline, Narcissistic, or Paranoid Personality Disorders, including those with high levels of psychopathy. Patients at seven TBS clinics were randomly assigned to receive three years of either ST or Treatment As Usual (TAU), and are being assessed on several outcome variables, such as recidivism risk (HCR-20, START), personality disorder symptoms (SIDP-IV, SNAP), and successful re-integration into the community. A three-year follow-up study will examine actual recidivism. One hundred and two patients are participating in the study. The preliminary findings from the first 30 patients to complete the three-year study suggest that ST is yielding better outcomes than TAU with regard to reducing recidivism risk and promoting re-entry into the community. These findings are not yet statistically significant, and thus need to be interpreted with caution until confirmed in our complete sample and follow up. However, they suggest that ST may be a promising treatment for offenders with personality disorders, including some psychopathic ones.

Arts therapies and Schema Focused therapy (SFT), use experiential techniques to help patients access and reprocess emotions. We conducted a randomized controlled pilot study to determine the effectiveness of these therapies at evoking emotional states ("schema modes") in forensic patients, a group that is considered difficult to reach emotionally. Ten male forensic patients with Cluster B personality disorders who were enrolled in a randomized clinical trial of SFT versus usual forensic treatment ("treatment as usual," TAU) participated in the study. We investigated the effect of Arts therapies versus verbal psychotherapy, and SET versus TAU on modes. As hypothesized, patients showed significantly more healthier emotional states in their Arts therapy sessions than in their verbal psychotherapy sessions SFT evoked more childmodes than TAU, at a trend level of significance. Patients in the SF-T and TAU conditions showed no differences in schema modes early in therapy, and were equivalent on all baseline characteristics. These findings, though requiring replication in a larger sample, suggest that Arts therapies and SET have potential for evoking emotional states in difficult to reach patients. (C) 2011 Elsevier Inc. All rights reserved.

Forensic assessment of personality disorders (PDs) is often hampered by patients' invalid self-reports. A less frequently used alternative in forensic settings is basing PD diagnoses on information provided by knowledgeable informants. Our research examined whether patients and informants in forensic settings differ in how they view PD symptoms, and whether that changes over time. For the purpose of our study, we adapted the informant version of the Schedule for Nonadaptive and Adaptive Personality-2nd Edition (SNAP-2) for forensic settings. Twenty-four male forensic inpatients with DSM-IV PDs were assessed with the informant SNAP-FI (completed by three treatment providers per patient) and a self-report version, the SNAP-FP. The SNAP-FI and SNAP-FP scales showed acceptable to excellent reliability. Across all time points, the SNAP-FI revealed more PD pathology than did the SNAP-FP. These initial findings support the value of informant reports in PD assessment in forensic settings.

Schizophrenic patients have difficulties in recognising previously presented verbal information and identifying its sources. The antecedents of these recognition and source misattributions are, however, largely unknown. The current study examined to what extent schizophrenic patients' lack of memory efficiency, their memory errors, and their source misattributions are related to neurocognitive deficits (i.e., executive dysfunctions).23 schizophrenic patients and 20 healthy controls were administered an adapted version of the Deese/Roediger-McDermott (DRM) task from which parameters of memory efficiency, memory errors, source misattributions, and two-high threshold measures were derived. Furthermore, two neurocognitive tasks tapping executive functions were administered: the Wisconsin Card Sorting Test (WCST) and the Behavioural Assessment of the Dysexecutive Syndrome (BADS). Using multiple linear regression analyses, we examined whether these neurocognitive measures predicted various memory parameters.Patients with schizophrenia showed poorer memory efficiency and were more prone to make internal-external source misattributions with high confidence. However, they did not more often falsely recognise critical lure words than controls. Executive dysfunctions predicted memory efficiency, but not source misattribution performance.Our findings provide further evidence that schizophrenic patients' memory impairments are intimately related to fundamental neurocognitive deficits.

Until recently few empirically supported treatments for patients with personality disorders were available. Schema Focused Therapy (SFT) has recently shown efficacy in (non-forensic) outpatients with Borderline Personality Disorder, raising the question if it may also be effective in forensic PD patients. For the past two years, we have been collaborating with Dutch forensic hospitals to adapt the SFT approach to meet the challenges posed by this population. In this article, we present our forensic modification of the SFT theoretical model, and make recommendations for the implementation of SFT in forensic clinical practice.