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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.

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.

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 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.

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.

The purpose of this paper is to explain that an integration of cognitivism with sociotherapy is possible and appropriate to help severe BPD cases. What follows is both an outline and a rationale of this integration.

Recovery programs for serious BPD represent a challenge because they require complex answers in three problematic areas: interdependent relationships, emotional intensity and identity, virtually at the same time. This prompted Raymond Gledhill Community the opportunity to integrate recovery programs with treatments that have yielded proven results for each cluster. Schema therapy and Systems Training for Emotional Predictability and Problem Solving have been integrated with sociotherapy.

This integration has led to considerable results including: increased motivation among the resident community, the adoption of a shared language, improved communication levels in the community, greater mutual support, increased trust in, and empathy toward, fellow residents, and more self-awareness – even among the facilitators.

It is the belief that the integration of cognitive tools with sociotherapy can indeed target recovery for people with BPD in a much more efficacious and cost effective manner.

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.

Despite the rising number of females in forensic psychiatry, research about their characteristics remains limited and is currently lacking in Belgium. Optimizing knowledge about the characteristics of these women will lead to a better understanding of this specific group. Therefore, the aim of the study was to gain insight into the characteristics of female forensic psychiatric patients in Flanders, Belgium.

A case file study was carried out in the forensic psychiatric hospital Sint-Jan-Baptist in Zelzate, Belgium. The files of female patients admitted in the period 2006–2017 were analysed (N = 82) based on a checklist including sociodemographic, mental health care and offence-related characteristics as well as historical risk factors.

The study revealed that female patients have been confronted with a large number of adverse experiences during both childhood and adulthood, were frequently diagnosed with borderline personality disorder and usually had an extensive mental health treatment history with many drop-outs. The majority of the female patients had committed violent offences towards relatives.

These findings are similar to those of other jurisdictions and highlight the importance of a gender-responsive treatment. This kind of treatment should include trauma-informed care, gender-sensitive risk-assessment and adapted versions of dialectical behavioural therapy and schema-focussed therapy. Additionally, treatment should focus on breaking the intergenerational transmission of violence and mental health problems by targeting parenting skills.

To the best of the authors’ knowledge, this is the first study that scientifically scrutinized the detailed characteristics of female forensic psychiatric patients in Flanders, Belgium. Recommendations for gender-responsive treatment and directions for future research are discussed.

The purpose of this paper is to investigate the views of young adult prisoners with emerging personality disorders (PDs), who were assessed as posing a high risk of causing serious harm to others, on the process of therapeutic change in a non-residential treatment service in a UK young offender institute. The treatment model utilises an integrated approach, specifically adapted for the developmental needs of young adults and combining therapies for PD with offence focussed interventions and regular keywork.

In total, 13 participants, who had completed at least one year of therapy, were interviewed about their perspectives about what, if any, change had occurred and how any reported change had taken place. The interviews were transcribed verbatim and analysed via thematic analysis.

All participants described having made positive therapeutic change. Three overarching change themes were identified: mentalisation of others, self-knowledge and adaptive coping. Relationships with staff were described as the key mechanism through which change was achieved. Specific treatment interventions were mentioned infrequently, although keywork and generic individual therapy and groupwork sessions were also described as drivers to change.

The findings suggest the possibility of positive therapeutic outcomes for this complex service user group. They also suggest that the domains of change and associated mechanisms may be similar to those reported for other service user groups and in other settings.

The purpose of this paper is to provide an overview of the rationale for appropriate treatment for offenders with personality disorder and intellectual disability co‐morbid with intellectual disability (ID), and to describe a specific treatment model.

The paper provides a narrative review of approaches to treatment for offenders with personality disorder and draws on the available research for the treatment of personality disordered offenders without ID as well as the treatment of offenders with ID.

The relevance and validity of the construct of personality disorder in intellectual disability is reviewed. Evidence from treatment of personality disorder in mainstream populations is summarized. A treatment model, which integrates adapted cognitive behavioural programmes with a social milieu approach, is then described. It is argued that this treatment model addresses the criminogenic, psychological and social needs of those with personality disorder and intellectual disability.

Services being developed for people with both intellectual disability and personality disorder should take account of the literature on treatment of mainstream personality disorder when developing treatment models.

There are few published papers concerning treatment approaches with offenders with intellectual disability and personality disorder. This descriptive paper will be of interest to clinicians working with such populations.