Therapeutic Relationships with Offenders: An Introduction to the Psychodynamics of Forensic Mental Health Nursing

Melanie Jordan (School of Sociology and Social Policy, The University of Nottingham, Nottingham, UK)

The British Journal of Forensic Practice

ISSN: 1463-6646

Article publication date: 16 August 2011



Jordan, M. (2011), "Therapeutic Relationships with Offenders: An Introduction to the Psychodynamics of Forensic Mental Health Nursing", The British Journal of Forensic Practice, Vol. 13 No. 3, pp. 213-214.



Emerald Group Publishing Limited

Copyright © 2011, Emerald Group Publishing Limited

Therapeutic Relationships with Offenders: An Introduction to the Psychodynamics of Forensic Mental Health Nursing (2009), represents part of a series, Forensic Focus, that is edited by Dr Gwen Adshead; this series presents clinical and theoretical debates associated with forensic psychotherapy, and also embraces various related disciplines (e.g. law, philosophy and language). Aiyegbusi and Clarke‐Moore's edited text comprises 16 themed chapters compiled by doctors, nurses and service managers/users from across the UK. Topics covered include (but are not limited to): working relationships between professional and user; adolescents in receipt of criminal justice system intervention; secure nursing care for women; balancing care and custody; comprehension of patients' communication of illness; institutional settings and therapeutic communities;, etc. Each chapter commences with a concise and useful introduction that permits the reader to assess the chapter's worth against their requirements.

Aiyegbusi's introductory chapter provides an overview of the book, including chapter summaries. To summarise: the text is intended to guide forensic mental health nurses in their relational task and their provision of containing yet therapeutic relationships with forensic patients, and to explore both the emotional impact of their work and the underpinnings of forensic patients' presentations (all in a manner that is specifically accessible to nurses); the nurse‐patient relationship is central to the purpose of the book. The text, as a whole, applies a psychodynamic approach to clinical interactions and therapeutic action: “the key is in understanding the difference between action that perpetuates the patient's difficulties and action that supports the patient to discontinue damaging patterns of relating” (p. 10). Aiyegbusi hoped that the book would inspire forensic mental health nurses to “to open up an avenue of therapeutic endeavour informed by an awareness of (the aforementioned) unconscious processes” (p. 10, square brackets not in original); fortunately, the subsequent chapters do serve to enthuse and educate concerning these powerful, yet intangible, interactions in clinical relationships and settings.

Such a short book review cannot evaluate all 16 chapters. Therefore, only one of the edited chapters shall be considered in detail here. Bose's chapter, “Containment and the structured day”, utilises the work of Bion, Klein, and Freud, plus the author's own clinical experience, to examine the provision of a timetabled existence for inpatients. A dynamic daily programme of structured activities is regarded as positive for myriad reasons. Bion's theory of psychological containment is central to the chapter. The forensic patient‐nursing staff relationship dynamic is debated and related back to patients' childhood experiences (often traumas) and relations with their mothers. It is accurately recognised that the creation of working and beneficial therapeutic relationships between patient and clinician are essential to any area of mental healthcare. The concise literature review that overviews the ideas of Klein and Bion is effective, and the argument constructed is compelling. The chapter highlights that a patient often seeks from their nurse the following attributes: sensitivity, understanding, empathy, thoughtfulness, but also consistency of presence and practice. The complications posed by potential/actual risk and security are included sensitively in the discussion; the challenging treatment versus security balance is addressed. An inpatient setting that promotes clearly defined set meal times, medication slots, timetabled group activities, obvious free time, a clear demarcation to the end of the day, etc. is supported. The nature of institutionalisation and a highly structured regime is tackled. The chapter does evaluate possible critiques of the containment and a structured day approach and potential problematic consequences of providing this form of therapeutic milieu. However, it is argued that the value of the structured day and this style of therapeutic relationship provides safe, boundaried and non‐chaotic healthcare environments for patients and staff. The demonstrated written dissemination skills of the author are both appropriate and good. Furthermore, the way in which the author, Bose, weaves in her prior nursing experience and expertise is honest and frank, but also highly apt and useful; the two case examples support the chapter well. This important and thought‐provoking chapter is a pleasure to both read and reflect upon.

Overall, the book serves as an excellent, and captivating, introduction to the psychodynamics of forensic mental health nursing. The text could be utilised for teaching purposes, but is also worthwhile reading for qualified clinicians who work with offenders. Furthermore, the book may also be useful for academics, such as medical sociologists and/or social scientists with a bent for health communication research. To conclude, this tome represents a welcome and valuable addition to the field.

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