How do high-risk young adult prisoners with emerging personality disorders describe the process of change in therapy?

Abstract

Purpose The purpose of this paper is to investigate the views of young adult prisoners with emerging personality disorders (PDs), who were assessed as posing a high risk of causing serious harm to others, on the process of therapeutic change in a non-residential treatment service in a UK young offender institute. The treatment model utilises an integrated approach, specifically adapted for the developmental needs of young adults and combining therapies for PD with offence focussed interventions and regular keywork. Design/methodology/approach In total, 13 participants, who had completed at least one year of therapy, were interviewed about their perspectives about what, if any, change had occurred and how any reported change had taken place. The interviews were transcribed verbatim and analysed via thematic analysis. Findings All participants described having made positive therapeutic change. Three overarching change themes were identified: mentalisation of others, self-knowledge and adaptive coping. Relationships with staff were described as the key mechanism through which change was achieved. Specific treatment interventions were mentioned infrequently, although keywork and generic individual therapy and groupwork sessions were also described as drivers to change. Originality/value The findings suggest the possibility of positive therapeutic outcomes for this complex service user group. They also suggest that the domains of change and associated mechanisms may be similar to those reported for other service user groups and in other settings.