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Dialectical behaviour therapy (DBT) has been widely used in a number of different settings with published outcomes and literature supporting its validity and efficacy. What is less understood is DBT’s application to forensic populations. The purpose of this paper is to qualitatively explore the experiences of high risk and adult male forensic clients (diagnosed with borderline personality disorder (BPD) and antisocial personality disorder (ASPD)) in a forensic adapted version of DBT.

Six clients who had completed four modules of DBT and individual therapy engaged in semi-structured interviews which were transcribed and analysed using thematic analysis.

The findings identified emerging themes relating to group processes and treatment outcomes. Specifically, the importance of motivation, shared learning, professionalism, reinforcement and reflection in creating a positive experience of DBT were identified. In addition clients identified feeling supported, a sense of belonging, personal achievement, increased knowledge and skills application as being part of their experience of DBT.

Whilst efforts were made to manage limitations, potential confounders include the impact of the researcher’s direct involvement in the facilitation of DBT and the small sample size.

This study provides support for the use of DBT with forensic males diagnosed with ASPD and BPD and the importance of the group component to the treatment modality. It emphasises the importance of group cohesion and the development of interpersonal factors including feeling supported, sense of belonging and a sense of achievement.

This paper provides a unique contribution to the understanding of the application of DBT with forensic male clients with personality disorder. It is the first known study to use qualitative methods to explore forensic male clients’ experiences of group and individual DBT. This paper provides insight into the key themes of clients’ experiences of DBT. These identified themes lend support to the importance of motivation of clients and the experience of shared learning, reinforcement and reflection. Furthermore, feeling supported, having a sense of belonging and a sense of personal achievement were identified as key to the positive experience of clients.

The purpose of this paper is to examine pre- to post-change in two components of implicit cognitive functioning following craving induction – attentional bias (AB) and executive control – of patients in a long-term drug-free residential treatment center that incorporated dialectical behavioral therapy (DBT) with usual therapeutic community (TC) practices.

Three groups of alcohol and cannabis dependent female adolescents were compared: pre-treatment (n=12), following four months of treatment (n=11), and following 12 months of treatment (n=7).

The results indicate significantly lower AB (as measured by visual probe task) and improved response inhibition (as measured by stop signal task) under craving conditions, after 12 months of DBT.

Naturalistic character of the study did not allow the use of repeated measures design, drug using control groups, randomized clinical trial, or performing a longitudinal follow-up. However, the findings show that DBT for drug abusing female adolescents in a long-term residential setting may be an effective intervention to enhance cognitive and executive functions critical to the risk chain involved in relapse and recidivism, supporting the implementation of DBT in TC residential settings.

This is the first research paper that examined effects of DBT+TC on substance dependent female adolescents’ cognitive mechanisms using well-validated behavioral tasks. The research provides some empirical evidence for the improvement in AB and response inhibition under craving conditions following treatment.

Borderline personality disorder (BPD) is a debilitating illness characterised by a pervasive pattern of emotional instability, interpersonal difficulties and impulsive behaviour in association with repeated self-injury and chronic suicidal ideation. People diagnosed with BPD also have high rates of co-occurring psychopathology, including disorders associated with disturbed impulse control, such as substance use disorder (SUD) and disordered eating behaviours. The co-occurrence of BPD and impulse control disorders contributes to the severity and complexity of clinical presentations and negatively impacts the course of treatment and recovery. This study qualitatively documents aspects of the lived experience and recovery journeys of people diagnosed with BPD and co-occurring SUD and/or disordered eating. This study aims to identify similarities with respect to themes reported at different stages of the recovery process, as well as highlight important factors that may hinder and/or foster recovery.

In-person, in-depth, semi-structured interviews were conducted with 12 specialist service consumers within a clinical setting. Ten women and two men (22–58 years; mean: 35.5 years) were recruited. Interview transcripts were analysed using thematic analysis principles.

As expected, participants with co-occurring disorders experienced severe forms of psychopathology. The lived experience descriptions aligned with the proposition that people with BPD engage in impulsive behaviours as a response to extreme emotional states. Key emergent themes and sub-themes relating to recovery comprised three domains: factors hindering adaptive change; factors assisting adaptive change and factors that constitute change. An inability to regulate negative affect appears to be an important underlying mechanism that links the three disorders.

This study highlights the potential shortcomings in the traditional approach of treating co-occurring disorders of BPD, SUD and eating disorders as separate diagnoses. The current findings strongly support the adoption of an integrative approach to treating complex mental health issues while concurrently emphasising social connection, support and general health and lifestyle changes.

The findings of this study contribute to the burgeoning BPD recovery literature. A feature of the current study was its use of in-depth face-to-face interviews, which provided rich, many layered, detailed and nuanced data, which is a major goal of qualitative research (Fusch and Ness, 2015). Furthermore, the interviews were conducted within a safe clinical setting with engagement facilitated by a clinically trained professional. There was also a genuine willingness among participants to share their stories in the belief that doing so would inform effective future clinical practice. Their willingness and engagement as participants may reflect their progress along the path to recovery in comparison to others with similar diagnoses. Finally, most of the interviewees were engaging in dialectical behavioural therapy (DBT)-style therapies; two were receiving mentalisation-based therapy treatment, and most had previously engaged in cognitive behavioural therapy or acceptance and commitment therapy-based approaches. The predominance of DBT-style therapy may have influenced the ways that themes were articulated. Future studies could supplement this area of research by interviewing participants receiving therapeutic interventions other than DBT for the treatment of BPD and heightened impulsivity.

This paper describes and analyses our experiences as lecturer practitioners working in the personality disorder service at Rampton High Secure Hospital. This service is an NHS Beacon site and hosts one of the pilot projects that are part of the Home Office and Department of Health initiative concerned with the assessment and treatment of people deemed to be dangerous because of the severity of their personality disorder. The paper focuses on the development of a competency‐based diploma/degree programme that is integrated with service priorities and clinical care pathways. The factors that shaped the evolution of this programme are outlined, supplemented by a critical commentary on how the course team experienced and made sense of the complex dynamics of the implementation process. Also discussed is the way our experience of facilitating dialectical behaviour therapy (DBT) group work influenced and helped us understand our work with students. Being active in service delivery ensured the course content developed from and reflected the realities of clinical practice. These issues are discussed with reference to the concept of parallel processes (Hawkins & Shohet, 2000) and by comparing the clients' experience of DBT groups with the students' experience of the competency programme.

There are a lack of recourses for substance abuse (SA) treatment for forensic clients with intellectual disabilities (ID). Many complexities arise when treating this population, calling for the creation of comprehensive resources which not only address the SA, but also account for the risk and offending issues. The purpose of this paper is to detail a pilot programme which aims to provide treatment for forensic ID clients with substance abuse issues as well as a significant risk of reoffending.

Six participants completed a 27-week SA treatment programme (the Alcohol and Substance Abuse Programme-Intellectual Disability) which incorporated the use of dialectical behavioural therapy (DBT) and the Good Lives Model concepts. Pre- and post-measures aimed to assess readiness for change and confidence in ability to stay clean and sober.

Preliminary findings showed a marked improvement in confidence of the participants’ ability to stay clean and sober in risk-related situations as well as an increase in overall readiness for change.

This research paper addresses a gap in the current forensic ID research and clinical treatment options pertaining to SA, by focussing on supporting forensic ID clients in their recovery journey from SA. Being at the forefront of SA treatment for forensic ID, further research in this domain should attempt to consolidate the findings of this programme.

The purpose of this paper is mainly to present a general review of third generation cognitive-behavioural therapies (CBTs), and to debate whether these approaches are applicable to persons with neurodevelopmental disorders (NDD).

Despite the lack of consistent literature focused on this population, the authors have considered the available general literature on the third generation of CBTs and analysed core issues of the processes within the context of intellectual disabilities and Autism spectrum disorder.

The evidence from typical developing population studies and the emerging literature specific to people with NDD is convincing, but there is a need for studies exploring how and when these therapeutic approaches can be applicable. Two behavioural approaches of third generation therapies – acceptance and commitment therapy and mindfulness-based CBT – appear to have the most potential to be adapted for robust intervention for the broad spectrum of persons with NDD.

The number of studies and methodologies applied are a clear limitation and the present paper is only exploratory.

The paper supports clinicians to use the emerging protocols, and to replicate and implement procedures and techniques.

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.

The purpose of this paper is to outline a clinical framework developed for autistic women. INVEST (Identify Needs, Validate, Educate, Strengthen and Thrive) is a strengths-based neurodiversity therapeutic approach. Autistic individuals are treated with respect and are believed to have the capacity to make meaningful changes in their lives.

The author’s clinical experiences working as an individual, couple and family therapist specializing in girls and women with autism inform this paper. The innovative therapeutic approach will be described including reasons for seeking therapy, the theoretical underpinnings and case examples that bring each component of INVEST to life.

Women with autism are very responsive to a therapeutic process that validates their experiences. Helping individuals and their support systems learn more about autism and their unique profile can enhance understanding and self-acceptance. Strategies to increase emotional awareness and reduce victimization are emphasized. Understanding sensory triggers and executive functioning challenges enable individuals to make useful adaptations. Building skills and setting parameters on time and energy help to stave off autistic burnout.

The impact of the INVEST model goes beyond the therapist’s office and can be applied to multiple settings. All professionals have the opportunity to treat autistic women with respect, validation and an assumption of competence.

Clinical program are scarce for individuals with autism, especially women. The INVEST model is the beginning of a discussion of what can help autistic women thrive.

This paper seeks to review the adaptation and application of mindfulness‐based psychotherapeutic practices for individuals with intellectual disability, the population most at risk for mental health and behavioral challenges.

Provided is an overview of the adaptation and utilization of these practices in the treatment of anxiety and mood disorders, and maladaptive behavior in individuals with intellectual disabilities. It also explores current research related to mindfulness‐based stress management for parents and caregivers of individuals with intellectual disability.

Current research and practice supports that mindfulness‐based psychotherapeutic practices are clinically effective in the treatment of anxiety, mood, stress, aggression, and self‐injury in individuals with intellectual disabilities, and enhanced coping and stress management in their parents and caregivers.

The effective, experiential, and skills‐based practices of mindfulness‐based psychotherapy make it easily adaptable and applicable for use with individuals with intellectual disabilities who have varying mental health and behavioral challenges.

Very little has been published on the adaptation and application of mindfulness‐based psychotherapeutic practices for individuals with intellectual disabilities. Given the mental health and behavioral challenges faced by this population, there is a great need for individuals with intellectual disabilities to have effective and practical treatment such as mindfulness‐based psychotherapy. Further research and utilization of these practices with this population is needed.

To examine how clinicians navigate providing treatment to Borderline Personality Disorder (BPD) in the context of the DSM 5, deinstitutionalization, and the biomedical model.

We conducted 39 interviews with mental health providers in the United States in a two-year period preceding and following the release of the DSM 5. Using Constructivist Grounded Theory, we analyzed the data for themes that emerged.

Clinicians faced pressures from insurance companies, the DSM categories, and their professional training to focus on biomedical treatments. These treatments, which emphasized pharmaceuticals and short courses of care, were ill-suited to BPD, which has a strong evidence base recommending long-term therapeutic interventions. We term this contradiction a “biomedical mismatch” and use Gidden’s concept of structuration to better understand how clinicians navigate the system of care. Providers ranged in their responses to the mismatch: some championed biomedicine, others were complicit, and a final group behaved as activists, challenging the paradigm. The sum of the strategies had downstream effects which included crisis reinstitutionalization and a discourse of untreatability. Ultimately, we discuss how social factors such as gender bias, stigma, and trauma are insufficiently represented in the biomedical model of care for BPD.

BPD fits poorly within the biomedical underpinnings of the current system. Accordingly, it illuminates the structuration of health care and where the rules of care break down. More precisely, deinstitutionalization was designed to remove patients from long courses of inpatient care. Many patients with BPD have failed to experience this outcome, with some patients now cycling through long courses of short-term crisis reinstitutionalization instead of having effective outpatient care over long periods. This unintended consequence of deinstitutionalization calls for a more biopsychosocial response to BPD.