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While there is general agreement in the literature regarding the importance of the therapeutic alliance (TA) in psychological interventions with people, the forensic context raises some unique challenges. The purpose of this paper is to discuss how these challenges are managed within a therapeutic context.

This paper consists of a literature review examining the following: the significance of the TA in interventions with forensic clients, especially men who have committed a sexual offence and the impact on treatment efficacy and change; therapist characteristics as well as some of the obstacles and challenges present in a correctional setting, which can impact on the TA and; the role of transference and countertransference in relation to these forensic clients.

Through the literature review, there is a discussion regarding how some of the common obstacles within correctional settings can be overcome, and how certain therapist qualities should be interpreted.

This paper will discuss some of the practical applications of certain recommended therapeutic factors within a correctional setting, challenging some of the common misconceptions and limitations. Furthermore, transference and countertransference, topics which are seldom discussed, will be considered in this paper.

The SECURE STAIRS framework for integrated care is a trauma-informed approach to supporting staff and young people within the Children and Young People’s Secure Estate (CYPSE) in the UK. Within secure settings, therapeutic climate is a concept that encapsulates an individual’s perception of safety, connectedness with others and level of support within the environment. To support evaluation of the SECURE STAIRS framework, a Secure Children’s Home (SCH) within the North East of England examined therapeutic climate for staff and young people annually using the Essen Climate Evaluation Schema (EssenCES) over a three-year period. This paper aims to present the findings.

Over the three years, a total of 71 young people and 214 staff EssenCES questionnaires were administered. Between 2020 and 2021, the setting also experienced significant changes resulting from the COVID-19 pandemic. Numbers of young people also decreased within the setting over the three-year period.

Results indicated a positive trend for therapeutic climate sub-scores. For example, Experienced Safety for young people significantly increased from 2020 to 2021. Additionally, therapeutic hold for staff was significantly higher in 2020 and 2021 in comparison to 2018.

Findings are discussed in relation to implementation of the SECURE STAIRS framework and providing trauma-informed care for vulnerable young people within secure settings. Implications for practice are explored.

The purpose of this paper is to explore the potential for personal and community transformation through storytelling within a therapeutic community (TC) through the analysis of one narrative case study.

The paper uses a narrative research design to describe and theorise the individual narrative of a TC client member, “Emily”, who self-identified areas of therapeutic change. Emily’s story is a single case of personal and community transformation. Analysis focussed on story of her weight loss to understand her changing role to herself and the community.

Emily’s story reveals the social complexities underpinning individual transformations within a community context. This complexity is particularly evident as Emily experienced visible weight loss but identified that the meaningful change is her changed relationship with herself and others. Using theories on symbolic interactionism, analysis of Emily’s narrative indicates the TC played a role in facilitating personal change and that through sharing her story with the wider TC, the community shifted its perspective on food and weight loss.

The paper expands the discussion on how storytelling practices within a TC contribute to therapeutic change. It is argued that community relationships play a key role in facilitating a changed relationship with self and others, and that stories themselves play an active role in shaping community meanings.

This paper has been written following an influential therapeutic encounter that we experienced while working with an emotionally distressed woman. The barriers that can get in the way of providing a structured therapeutic approach are discussed. The paper focuses on dialectical behaviour therapy as a treatment model, and discusses how the concept of ‘dialectics’ provide an over‐riding context for case conceptualisation (Linehan, 1993). The dialectical dilemmas and powerful dynamics that can be enacted between individuals, teams and patients in their endeavours to cope with distress will be illustrated. The dialectical philosophy is described and elaborated upon, providing a framework for the synthesis of clinical interpersonal encounters and metaphorical concepts of a therapy seesaw. The paper discusses how these ideas can guide us in our work with emotionally distressed individuals.

Offending behavior change programs play an important role in the prevention of criminal behavior, particularly when offered to violent offenders. There is, however, little consensus about how content should be delivered, despite agreement that the development of a strong therapeutic alliance (TA) is an important determinant of outcome. The purpose of this paper is to explore how the TA is formed within correctional programs.

In total, 27 therapists who delivered correctional group treatment explored issues relating to the role of the alliance in offending behavior programs. A grounded theory methodology was employed to develop a conceptual understanding of therapist perspectives and practises.

Three different modes of practice were identified: “educative” to enforce boundaries of group behavior; “engagement” to promote a collaborative approach; and “therapeutic” to enhance client insight.

Greater awareness of the skills and supports required to successfully develop strong TAs in correctional populations may assist better retention and treatment outcomes in offending behavior programs. The ability to work flexibly between different modes of practise may prove important to rehabilitation efforts.

A model of the TA based on therapists’ accounts of their practise in correctional programs is presented. It is anticipated that, particularly for novice correctional therapists, exploration of the ways in which the alliance can be established and ruptures responded to will enhance treatment efficacy, particularly in treating violent offenders who can be challenging to engage.

Cognitive-behavioural interventions, such as the substance related offending behaviour programme (SROBP), are being implemented across forensic contexts in an attempt to address the detrimental economic, social and personal impacts of substance use and offending. Whilst support exists for the effectiveness of such treatment, there remains to be limited knowledge of offenders’ experiences of treatment and factors that promote treatment efficacy and support desistance. This study aims to develop an idiographical understanding of those processes.

Six prisoners who had completed the SROBP were interviewed via a semi-structured schedule to collate their individual experiences of engaging in treatment. Interviews transcripts were analysed by the lead researcher using interpretative phenomenological analysis, and external auditing analysis was conducted by the research supervisors.

Three superordinate themes resulted: “Therapeutic processes and relationships,” “Therapeutic outcomes” and “Threats to post treatment recovery.” Participants identified factors which facilitated the effectiveness of treatment and were effective in meeting their needs, although there were other factors that required improvement.

The important role of motivation at various stages of treatment as this engenders commitment to treatment aims and longer-term recovery. Treatment efficacy is linked with perceived relevance and value of treatment outcomes in supporting desistence from substance use. Pro-social peer relationships are important for effective application of learning and recovery. Attentiveness to participants specific needs is required. The lack of post-programme support has the potential to threaten therapeutic alliances and reinforce experiences of rejection and abandonment. The management of the exit phase from programmes is critical.

Results are discussed in light of their implications for future working practices in supporting therapeutic processes and rehabilitative culture.

The purpose of this paper is to review issues of relevance to practitioners using group cognitive behavioural therapy (CBT) with women in secure settings.

The extant literature on CBT as applied to women in secure settings is reviewed to highlight best practice. Aspects of best practice are illustrated with examples from a women's medium secure service.

Obstacles include the characteristics of the patient group, treatment non compliance and an environment that accepts the primacy of security over treatment. Environmental and need factors amenable to intervention are highlighted in addition to CBT specific considerations that include the timing and intensiveness of treatment, content and delivery of therapy, treatment readiness and use of the group process. The use of a manualised CBT group treatment aid attempts to ensure treatment integrity is associated, and which is associated with treatment outcome. A focus on the social and environmental factors that attribute to the therapeutic milieu is vital to treatment generalisation, as is harnessing the therapeutic potential of the built environment. Finally, treatment evaluation imposes a structure that can facilitate progress in treatment.

There is comparatively little work on CBT group treatments for women in secure settings. Attempts to synthesise best practice initiatives in this area are helpful in guiding treatment developments.

The purpose of this paper is to propose that some level of disorder in daily life can be of benefit. The article aims to draw from recent ideas suggesting that chaos in a business setting has the potential to yield rich gains, and consider how these might be applied to a therapeutic community (TC) setting.

The authors combine sociological approaches with trends in commercial contexts to reflect on the potential implications for TC environments.

The instinctive quest for stability, control and continuity is suggested to run counter to the need for change at an organisational level. Chaos can be considered as both disorder and hidden order, each creating opportunities for positive change through a chaordic process. It is suggested that TCs are well‐suited to embrace the relational dynamic required, if they are willing to engage in this chaos organisationally.

The article has a very serious and far‐reaching range of implications for TC life, in suggesting that at an organisational level TC processes should be designed to accommodate the chaordic process. Rather than the TC simply being a container in which therapeutic change happens, it is proposed that the TC itself can undergo a dynamic of discontinuous change that brings additional benefit to its members.

This article is intentionally interdisciplinary, embracing thinking from the social sciences, especially sociology, as well as recent examples from business and organisational theory. In bringing some of these ideas into TC life the authors are also drawing on their own research and findings from founding and running a TC, observing on numerous occasions the positive outcomes following times of chaos, disorder and upheaval in the lives of clients and the TC.

Psychiatry in its traditional form, often relegates the patient to a passive recipient, and removes his/her agency. The paper aims to examine the reasons for this and the value of it from a largely theoretical perspective.

The literature is examined on the responsibilities removed from patients by prescribing treatment, both medication, and psychotherapy.

The literature describes how humans in their collectives, groups or communities, generate commonly held attitudes, which may coerce patients into certain roles, and to give up their responsibilities and their agencies. It is postulated that this is possible in a therapeutic community where the unconscious dynamics could resemble those of psychiatric units.

The significance of the findings is that some degree of vigilance has to be maintained over what sets of attitudes develop in a community and especially the role that patients are assigned.

The findings suggest that the therapeutic community method should not be idealised but can go wrong, or can harbour coercive un‐therapeutic influences. There needs to be some continuing awareness of the development of such dynamics.

This chapter explores the transformation that occurs during an Appreciative Inquiry (AI) summit through the lens of Rogerian client-centered therapy. The client-centered approach stems from the work of Carl Rogers, who theorized that humans have a tendency toward self-actualization, or that they can be trusted to move constructively toward the fulfillment of their inherent potential. According to Rogers, a client-centered therapeutic approach enables an individual to radically alter the self-concept and achieve transformational change, but only when six specific conditions are met. When these conditions are met, the result is generativity at the individual level as the client’s world opens up with new possibilities. Starting from the assumption that individuals and higher-level human systems share common elements as open systems, the opening up of the self-structure at the individual level can be seen as similar to the system coming together in a generative way during an AI summit. Rogerian theory and AI share a common set of underlying principles, and these principles guide the similar approach to change at these different levels. Here, a community AI summit in Worcester, Massachusetts, is viewed through a Rogerian lens in an attempt to shed light on how these conditions might also operate in higher-level human systems aimed at enabling generativity.