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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 paper describes the clinical and risk characteristics of patients admitted over the first four years of operation of the Dangerous and Severe Personality Disordered (DSPD) NHS pilot at the Peaks Unit, Rampton Secure Hospital. There were 124 referrals, mainly from Category A and B prisons, resulting in 68 DSPD admissions. Clinically, 29% scored 30 or more on the Psychopathy Checklist. The most common personality disorders were antisocial, borderline, paranoid and narcissistic. There is a high risk of violent/sexual recidivism as measured by the Static‐99, Violence Risk Scale, and the Historical, Clinical and Risk Management Scale.

This review aims to focus on men who access, download, and circulate child abuse images across the internet as the most frequently occurring type of internet sex offender.

Some of the misconceptions associated with this behaviour are outlined and the extent to which internet offenders display some of the criminogenic factors thought to be associated with the multi‐factorial theories of sexual offending are reviewed.

One conclusion from this is paper is the general impression that internet offenders show many of the characteristics of paedophiles. Their theoretical importance is that they appear to be “desisters” from acting out their sexual interest in children by hands‐on offending.

It is argued that there is a need for more research to stimulate our understanding of this type of offender. Furthermore, what of those who both download material and offend directly against children? They present a dilemma for the literature as some research would suggest that they are not entirely like the internet or the contact sexual offenders in their psychological make‐up; they are the group most in need of reappraisal.

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 three aims of the study reported were to investigate the functions of self‐harm in a population of patients detained in the Peaks Unit at Rampton hospital, to investigate the context and nature of this behaviour and to examine how staff respond to incidents of self‐harm. The findings indicate that there may be some functions of self‐harm specific to this population in addition to those found in other settings, namely expression of aggression and revenge. The context and nature of incidents were similar to those found in other secure settings. A range of staff responses were observed, and indicated high demand on staff time and resources. Limitations of the methods are discussed, with proposals for future research.

Data gathered from routine clinical settings is complementary to evidence garnered from controlled efficacy trials. The purpose of this paper is to present individual-level analysis of changes in a group of patients discharged from psychological therapy within an outpatient pain service. The service had recently shifted from a traditional cognitive-behavioural approach to one underpinned by Acceptance and Commitment Therapy.

Reliable and clinically significant change methodology was applied to CORE-10 outcomes for 27 patients discharged during 2013-2014. Outcomes were compared to 2012-2013. A patient satisfaction questionnaire was administered and functional outcomes were collated.

Outcomes were not adversely affected by the shift in service focus as clients demonstrating reliable improvement increased from 2012-2013; 81 per cent reliably improved, 44 per cent made a clinically significant improvement. Increases in returning to work/unpaid activities at post-treatment were noted. The service met a number of NICE quality standards concerning the “relational” aspects of care.

Clinical effectiveness is evaluated through one outcome measure thereby limiting conclusions. The longer term effectiveness of the service remains unclear. Narrow demographic information limits an assessment of any systematic biases in findings. Little is known about treatment drop-outs.

A number of recommendations concerning data collection and future service evaluations are made.

Returning to paid or unpaid activities has a high public health impact.

This paper contributes towards the evidence base for using psychological therapies with clients experiencing chronic pain and related distress. Importantly, the paper complements evidence for general efficacy (from large-scale controlled studies) through an evaluation of real-world effectiveness (i.e. practice-based evidence).