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Psychological Therapies with Women in Forensic Mental Health Settings

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.

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Psychological Therapies with Women in Forensic Mental Health Settings

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  1. 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

  2. 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

  3. Psychological Approaches • 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)

  4. 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

  5. Case Examples

  6. 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

  7. 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?

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