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The purpose of this study/paper is to describe the implementation of a six-month schema therapy awareness (STA) group. Research supporting individual schema therapy (ST) as an effective intervention for personality disorder is growing steadily within a number of settings including with forensic patients. Alongside individual ST, positive results have been reported for group ST. However, to the best of the authors’ knowledge, no current published research exists with regard to the use of group ST within forensic populations and more specifically within a low secure environment.

This paper describes the implementation of a six-month schema therapy awareness (STA) group with individuals situated within a low secure environment.

For individuals transitioning into the community from a secure setting, the focus of risk management should attempt to move away from external controls towards more of a reliance on internal factors. In ST, this is achieved by understanding the role of schema modes (and underlying schemas) that are linked to an individual’s offences/risk and developing this understanding into a coherent and accessible formulation for the individual to make changes.

Further robust research evaluating clinical change is recommended as the next step.

The group protocol is described along with the challenges and potential solutions experienced during the implementation. This provides an opportunity for other professionals to replicate this approach in the future.

With regard to group ST within forensic populations, the research is sparse at present and this study focusses on practical application of theory and the challenges of operationalising a STA group.

Schema therapy has gone through various adaptations, including the identification of various schema modes. The purpose of this paper is to suggest that there may be a further dissociative mode, the “frozen child” mode, which is active for some patients, particularly those that have experienced extreme childhood trauma.

The paper is participant observer case study which is based on the personal reflections of a forensic patient who completed a treatment programme which includes schema therapy.

The proposed mode, “frozen child”, is supported by theoretical indicators in the literature. It is proposed that patients develop this mode as a protective strategy and that unless recognised and worked with, can prevent successful completion of therapy.

Based on a single case study, this concept is presented as a hypothesis that requires validation as the use of the case study makes generalisation difficult.

It is suggested that if validated, this may be one of the blocks therapists have previously encountered that has led to the view that people with severe personality disorder are “untreatable”. Suggestions are made as to how patients with this mode, if validated, can be treated with recommendations as to the most appropriate processes to potentiate such therapy.

The suggestion of this potential “new schema mode” is based on service user initiative, arising from a collaborative enterprise between service user and clinician, as recommended in recent government policies.

Research suggests that the majority of forensic clients have significant personality difficulties. Providing quality nursing care to this client group is identified as particularly difficult. This paper outlines how schema‐focused therapy has been introduced to nursing staff working with personality disordered clients in an in‐patient setting in order to enhance their practice with this client group. A brief overview is given of Young's (1994) schema‐focused therapy model and a detailed description of how this model has been incorporated into in‐house training and used to guide nursing treatment plans and individual nursing interventions. Although this strategy has not been formally evaluated, feedback suggests that both staff and patients believe that the quality of care provided since its introduction has improved significantly.

Psychiatric nurses were given training in schema‐focused therapeutic approaches. They were then applied in a forensic setting with a focus on the needs of those patients diagnosed with a ‘personality disorder’. The paper discusses and reflects on the results of the approach and its relevance to the training of psychiatric nurses.

This discussion paper aims to further explore narcissistic vulnerability as a psychological concept in relation to stalking, adding to the literature base by resurrecting this focus and exploring practical implications of this association through proposing a schema therapy (ST) approach.

Stalking results from an interaction of circumstances and a vulnerable personality. Understanding the psychology of those who stalk, before and during stalking episodes, is pivotal in helping the person stalking to desist and thus protect victims. Knowing how to most effectively intervene at the earliest opportunity with those stalking is an area receiving renewed attention. Not least due to the improved identification of stalking, but also the continued absence of empirical evidence on effective intervention approaches. This paper sets out to explore the utility of ST with stalking cases.

Recent research undertaken by Wheatley et al. (2020) with men who had stalked and were detained in prison within the UK highlighted narcissistic vulnerability as a key feature in their personalities. The original study provided support for the linked conceptualisations of narcissistic vulnerability, preoccupied attachment styles and the phenomenon of stalking. This paper extended discussions to explore the utility of ST to address narcissistic vulnerability in stalking cases.

This is an original discussion paper combining research with stalking cases, practitioner specialism, psychological theory and existing empirical literature to argue for the value of ST for addressing stalking.

The purpose of this paper is to increase our understanding of the role of mental disorder in sexual offending as well as identifying innovations in assessment and treatment with offenders who present with these typically complex risks and needs.

The converging literatures on “good lives” and other developments in sexual offender treatment are compared with recovery from mental disorder and what is known about the particular needs and characteristics of sexual offenders with mental illness and severe personality disorder (PD).

A key outcome of this review is that many mentally disordered sexual offenders have similar needs to those in prison and the community but there are particular challenges posed by severe PD, paraphilias and the relatively rare individuals whose offending is functionally linked to psychotic symptoms.

Practical implications include the need for case formulation of complex needs related to mental disorder using direct and indirect measures of attitudes and interests. Treatment needs to be responsive to very different personality and mental health presentations as well as problems with offending and cognitive schemas. Direct functional links between mental health symptoms such as delusions and hallucinations are very rare in practice and are usually secondary to PD and sexual offending issues. In practice, treatment promoting recovery from mental disorder is highly compatible with the “good lives” approach to sexual offender treatment. Staff development, supervision and support are particularly important for staff treating mentally disordered sexual offenders.

It is argued that mentally disordered sexual offenders are an under-researched sub-group within the wider sexual offender population. This paper brings together the relatively limited literature on treatment with examples of recent treatment innovations, multi-modal assessment approaches and reviews of research on the needs of this relatively uncommon but highly risky group.

The purpose of this paper is to explore service users’ experiences of the process of ending from national health service (NHS) community personality disorder services.

Semi-structured interviews were conducted with eight participants recruited from four NHS community personality disorder services.

Three main themes emerged; “Service users” experiences in the context of “Reflective versus Reactive practice”, “Endings held in mind” and “What next”?

Further recommendations are provided for practitioners supporting individuals managing endings alongside a “readiness to end” model which may be used in clinical practice.

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.

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.