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As a practitioner working in the field of adult protection I became aware that, although the responses to reports of abuse have become more effective and consistent, access to treatment or therapy is limited. I therefore decided to explore the idea of using psychological approaches as interventions. My background is as a registered nurse and CAT (cognitive analytical therapy) practitioner. From some limited experience I have found that CAT can be a successful approach. In the course of this article I will examine the background to adult protection work in the UK, focusing on elder abuse, including self‐neglect, in domiciliary settings, to show the need to explore new approaches to treatment for both those who have been abused and those who are in the position of abuser. A selection of psychological therapies are explored to determine their potential to offer support for this group and the article concludes with examples of the use of CAT with adult protection referrals and a summary of the benefits and obstacles to this approach.

Cognitive analytic therapy (CAT) has a developing evidence base for working with complex cases including personality disorder. This article describes the use of CAT with a single 25‐year‐old male patient with severe personality difficulties who was residing in a medium secure hospital. It is suggested that, in treatment of severe personality difficulties, rather than aiming at ‘cure’, therapy may have a more modest goal such as movement from personality‐disordered functioning to adequate or optimal personality functioning.

This paper aims to describe issues clinicians encounter when delivering cognitive analytic therapy (CAT) within a high secure hospital (HSH).

Focus groups were conducted with six staff using a semi‐structured interview. Thematic analysis was used to analyse the data.

Five main themes emerged from the data. These were: concerns around therapy and the therapeutic relationship; issues with CAT stages and structure; issues around CAT tools; issues connected with the HSH setting; and concerns about integrating CAT and teamwork. Clinicians addressed these issues by helping others understand therapeutic relationships and adapting CAT tools and structure.

It is recommended that HSH managers ensure that therapists are fully supported and subsidiary therapy staff members are appropriately trained. Additionally, the Association for Cognitive Analytic Therapy (ACAT) and CAT training organizations need to demonstrate sensitivity to the HSH context and fully prepare trainees for forensic work.

This paper describes how clinicians effectively address challenges when delivering CAT and makes recommendations for future delivery.

The purpose of this paper is to provide some practice considerations for working with personality disorder, focusing on the application of assessment, formulation and therapy to complex populations such as forensic clients. In addressing this it outlines the concept of a Multi-Modal Integrated Therapy (MMIT) and how this is applied to personality disorder intervention.

The core elements to consider in the provision of an integrated approach are outlined, informed by a review of the relevant literature. The paper does not aim to provide evaluation data but is intended to be a clinical practice document.

The value of integrating the effective components of therapy to address all aspects of working with forensic populations is evidenced. It is argued that appropriate approaches will capture cognitive components (including Early Maladaptive Schemas and also adaptive schemas), Cognitive Analytic Therapeutic approaches and Dialectical Behaviour Therapy components to produce an effective framework to capture the complexities of personality disorder in forensic populations.

The paper outlines how a move away from focusing on a single approach to understanding and intervening with personality disorder is key with complex populations, such as those found within forensic settings. The authors argue that practitioners should focus routinely on the importance of integration of principles relevant to personality disorder work.

The paper argues for: Adopting a truly multi-modal integrated approach to interventions with personality disorder, highlighting the importance of MMIT. The importance of accounting for complexity in personality presentation in forensic populations and capturing positive as well as negative functioning. The value in identifying what is effective within existing therapies and applying these components as part of a wider package. The core elements of an effective approach are indicated.

The purpose of this paper is to report the evidence base for the practice of individual psychodynamic psychotherapy with adults with intellectual disabilities (IDs).

Literature review.

In total, 14 papers were reviewed. From these, one existing review and seven individual papers provided enough evidence to support effectiveness of individual psychodynamic psychotherapy for people with IDs.

This research indicates individual psychodynamic psychotherapy to be of benefit. Indeed, all studies reviewed supported individual psychodynamic psychotherapy, but methodological shortcomings weakened the confidence placed in findings for some studies. Limitations of this review include methodological shortcomings of studies reviewed, a small number of existing studies and reliance on case studies.

Therapists and commissioners of services should routinely make individual psychodynamic psychotherapy available as part of a spectrum of therapies available to people with IDs who experience emotional and behavioural problems. This is because it is needed for some clients and they benefit.

Individual psychodynamic psychotherapy for people with IDs adds to the range of therapies available to alleviate emotional distress and enhance well-being. These are necessary to provide a foundation for meaningful contribution to society, particularly for those who have experienced psychological trauma (Frankish, 2016).

This review includes more relevant studies than previous reviews and adds to a limited number of reviews in this area.

This paper aims to provide practitioners with a brief but comprehensive review of the current evidence base for psychological treatment approaches used in the UK that may be useful for stalking therapies.

A rapid evidence assessment was conducted on papers (post the UK Protection from Harassment Act, 1997) that discuss treatments of stalking (with or without a conviction) and associated offences/disorders. Therapies reviewed were Acceptance and Commitment Therapy, Cognitive Analytic Therapy, Cognitive Behavioural Therapy, Dialectical Behaviour Therapy and Schema Therapy. Searches for Mentalization-Based Therapy and Psychodynamic Therapy in relation to stalking were also performed but yielded no results that met inclusion criteria.

There is currently a severely limited evidence base for the efficacy of the psychological treatment of stalking behaviours. Some interventions show promise although a multifaceted, formulation-based approach is likely to be required.

Future research would benefit from robust studies focused on stalking with long-term efficacy follow-ups.

To the best of the authors’ knowledge, this is the first rapid evidence review of psychological treatments that directly address stalking behaviour.

People with learning disabilities are subject to the same range of psychological disorders as non‐learning‐disabled groups. Although in the 1970s and 1980s many therapeutic interventions were based on psychological theories of learning, there has recently been a large expansion in the types of therapy on offer. They have included increasingly sophisticated use of models based on learning theory and the incorporation of a diverse range of other therapeutic models. Although Reports in the literature of successful therapeutic intervention are becoming more common, they largely fail to address the reality of clinical work, which may require a multi‐level approach, for extended periods of time.

This paper provides a clinical practice overview of the challenges that can arise when working with dangerous and severe personality‐disordered patients in a high secure hospital. Poor engagement and treatment readiness, mistrust, paranoia and dominant interpersonal styles are all clinical features that affect treatment delivery. The paper discusses the impact of these features, and suggests how clinicians can engage effectively with individuals who have personality disorders in regard to therapy in general.

This single case study design describes the process in the care and treatment of Martin, a 28‐year‐old man with a learning disability and a diagnosis of emotionally unstable personality disorder within a medium secure unit for people with learning disabilities and associated difficulties. The purpose of this project was to make clear the links between understanding the personal phenomenology through formulation and therapy and the usefulness of this ‘knowledge’ in helping to guide difficulties, impasse and nurture positive relationships. The central theory underpinning treatment was cognitive analytic therapy (CAT), with an emphasis on the relational components and shared formulation.

There is limited research on Cognitive Analytic Therapy (CAT) in forensic contexts; this case study therefore significantly contributes to the knowledge base. The purpose of this paper is to present the assessment and treatment of an adult male offender with a diagnosis of schizophrenia. The client’s offence involved intimate partner violence and was committed at a time of acute psychiatric relapse.

In total, 12 sessions of cognitive behavioural therapy and CAT informed treatment were individually designed to meet the needs of the client, delivered in an in-patient setting in the UK. The client’s progress was assessed using psychometric, observational, and narrative/descriptive methods.

Psychometric evidence was limited by distorted responding. However, narrative/descriptive assessment indicated that progress had been made in some areas. Recommendations for further treatment were made.

In total, 12 sessions did not meet all of the client’s needs. The use of CAT as a model that his team could use in understanding his violence was conducive to risk management. Overall, insight gained through CAT-based psychological intervention contributed to risk reduction.

This case study demonstrates the applicability of CAT to forensic settings.