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This paper aims to discuss a service user perspective of factors that influence engagement in therapeutic group‐work within a high secure hospital environment.

An opportunistic sample of 11 male service users were interviewed, using a semi‐structured protocol. This was underpinned by social and psychological factors highlighted within the literature, and concepts drawn from the Health Belief Model (HBM). In accordance with service‐user led initiatives, interview questions were open‐ended, designed to invite and encourage exploration of themes through general discussion. Research findings were analysed through an interpretative phenomenological analysis (IPA) approach to identify emergent themes of apparent influence. Themes were identified, and were categorised into emergent themes and related sub themes. Emergent themes were then considered in relation to the theories and concepts that underpinned and connected them.

It was found that the most substantial theme was culture of the environment, closely linked to the concepts of choice, which stem from and are greatly influenced by culture. Participants highlighted additional influential areas, namely relationships, trust, motivation, group‐work content and expected outcomes.

Given the complexities of need presented by service users within high secure settings, professionals recognise a range of approaches and treatment modalities incorporating individual therapy, occupational and vocational engagement and therapeutic group‐work. It is specifically service users' views of engagement in such group‐work that is considered within this paper.

This paper outlines researcher–practitioner reflections on the use of a visually adapted repertory grid technique (VARGT) with men convicted of stalking. It draws on and assimilates participant experiences of the VARGT as a research engagement tool. Further, it extends discussion to propose its value as a generic engagement tool for when personal insights and collaborative case formulations may otherwise be difficult to access.

The repertory grid technique, developed from Kelly’s Personal Construct Theory (1955), was adapted visually for utility in a mixed methods research study with those who commit stalking offences (Wheatley, in preparation). Analytical and reflexivity processes within this original study highlighted rich and recurrent data across the sample pertaining to the positive participant experience of the VARGT, unrelated to its core research question.

This paper presents reflections and psychological discussion for experiences of using the VARGT. Key features clustered around therapeutic alliance and engagement, enlightenment and a motivation for positive change.

This paper suggests the VARGT has value in participant–client engagement, particularly where sensitive topics are being investigated and participants have difficulty directly articulating their psychosocial functioning.

This novel technique offers potential as an engagement tool for use in research and clinical settings.

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.

Despite the importance of increasing engagement and minimising attrition and drop‐out in parenting interventions, there is a paucity of empirical evidence examining factors related to engagement and participation. The range of factors examined in relation to engagement is generally limited in scope and variety, focusing on variables of convenience rather than utilising a theoretically‐driven approach.The aim of this article is to review the factors related to parental engagement with interventions and to describe strategies and implications for improving engagement with parenting interventions. Several policy and practice implications are identified: (1) Poor parental engagement may threaten or compromise the capacity of parenting programmes to deliver valued outcomes. Viable engagement strategies need to be a core part of prevention and early intervention parenting programmes; (2) Agencies delivering parenting services need a proactive engagement strategy, which includes strategies to prevent drop‐out, as well as strategies to actively respond to parental disengagement; (3) Research is needed to test the efficacy and robustness of different engagement enhancement strategies. Empirical tests are needed to test the effectiveness of different engagement strategies in order to ensure that the most efficient, cost‐effective and efficacious approach is used in order to engage parents. Investment of research effort to improve parental engagement is likely to have a high yield in terms of programme efficiency, utility and cost effectiveness. We conclude that research examining how to improve engagement and decrease non‐completion is needed to strengthen the population level value of parenting programmes as preventive interventions.

The purpose of this paper pertains to the implementation of an occupational therapy service within a newly‐established medium secure service for 16 men with intellectual disabilities and additional diagnosis of personality disorder located in the North West of England.

This is a general review, providing a descriptive account of the development and implementation of an occupational therapeutic provision for men residing in a medium secure unit with a dual diagnosis of intellectual disability and personality disorder and a service user account of its efficacy.

The paper seeks to illustrate the efficacy of occupational therapy implemented by a specifically recruited and trained staff team, describing engagement in meaningful, bespoke programmes of occupation used to assist service users to address deficit areas via mutual engagement in activities, serving to facilitate the formation and development of positive and trusting relationships between service users and staff. The impact of the service is described from a service user's perspective.

There is very little literature relating to those with intellectual disability also diagnosed with personality disorder. There appears to be no specific study of occupational therapy amongst those with dual diagnosis of intellectual disability and personality disorder. This paper is therefore unique in its approach and provides an overview of both the process and method used to implement occupational therapy, as well as a service user perspective and an illustration of its efficacy in a medium secure setting.

There is evidence that attachment style and clinical outcomes are related within Therapeutic Communities (TCs). This paper aims to examine any possible relationships between self-reported adult attachment style, therapy programme engagement and measures of psychological distress and dissociation on admission and discharge within a residential TC.

Ex-clients of the TC were contacted by post and invited to take part in this service evaluation. Additional data were sourced from a database of routinely collected outcome measures. Of 281 ex-clients, the final sample in this study was N = 32.

When attachment style is conceptualised dimensionally, participants identified most strongly with a fearful attachment style, and least with a preoccupied or secure style. A range of attachment styles were reported. A significant association was apparent between self-reported secure attachment and reduced levels of psychological distress upon discharge from the TC. The potential for changes in client attachment patterns following TC membership is discussed.

The small sample size and correlational nature of this study means that results should be interpreted cautiously. Nevertheless, results are of clinical relevance for inpatient or residential therapy programmes (including TCs). Such programmes should routinely assess client attachment style to ensure appropriate interventions and adaptions are implemented.

To the best of the authors’ knowledge, to date, this is the first known study to report on the relationship between self-reported adult attachment style and psychological outcomes specifically for women with self-defeating behaviours within a TC.

The purpose of this paper is to summarize the main findings and conclusions of four separate studies on treatment in therapeutic communities (TCs) for addictions.

The first two studies address the core characteristics of the TC approach: a study on the workable and destructive elements of the Synanon model; and a comparative study on the essential elements of TCs for addictions in Europe and in the USA. The final two studies highlight clients’ perceptions of the TC treatment process in relation to retention: a study on clients’ first month perceptions of the TC treatment process and the influence of fixed and dynamic client factors; and a longitudinal study on changes in clients’ perception of the TC treatment process and the impact of motivation, psychological distress and cluster B personality traits.

The first study showed that Synanon’s therapeutic and pedagogical methods are still highly valued despite its negative reputation. The results of the second study suggest that while traditional TCs operate as concept-based TCs in Europe, modified TCs might differ in the extent to which they apply the core principles and elements of the TC approach. The third study provides evidence that suitability for treatment is a very important predictor for clients’ first month perceptions of the community environment. The fourth study shows that with time in treatment clients develop more profound perceptions regarding the essence of TC treatment.

Finally, implications for clinical practice, general limitations and some concrete recommendations for future research are presented in this paper.

The PhD summary study contributes to the existing literature on TC treatment.

A case study approach to highlight the use of cognitive neurological rehabilitation in the therapeutic management of two service users who have a diagnosis of learning disability and who have exhibited the extremes of aggressive and challenging behaviour. The purpose of this paper is to explore the remarkable progress made by two service users for whom services seemed to be at a loss as to how to meet all but there basic needs. Their journeys from hopelessness to optimism and recovery are both attributable to the cognitive neurological rehabilitation model and how staff and service users worked together to gradually regain control.

A case study approach highlighting the value of training, team working and a therapeutic model and the impact this has made on service users who, in the past, where labelled as highly disruptive and potentially untreatable.

That the cognitive neurological approach is effective in managing service users who have certain cognitive deficits in a structured and supportive way that allows positive progress towards recovery.

A very practical intervention that can be taught and supported. An intervention that appears to achieve excellent clinical results.

Very original and effective approach to care and treatment of service users with diagnosis of learning disability living in conditions requiring security.

The purpose of this paper is to examine the supportive aspects of a team approach for a remote mental health team that report high stability in senior clinical roles, in a region where voluntary turnover is typically high.

This qualitative research study examines the reflections of team members on their role and job characteristics through informal semi-structured interviews.

The extant themes identified as supportive aspects of the team approach included engagement and both personal and professional support. The intrinsic role of support in remote work environments, and the impact of intrinsic job satisfaction through client-focussed practices further supported low turnover, improved stability and consistency of service provision.

Continued support for existing experienced health professionals will contribute to workforce stability in remote regions where needs are complex and continuity of care is improved by consistent, reliable services. With health professionals working in remote Australia reporting high levels of job satisfaction; it follows that the next steps involve minimising dissatisfaction through effective workforce support mechanisms. Health professionals already working in remote regions, suggest that this is about engagement and personal and professional support through flexible work systems. While the findings of this study may not be generalisable, the authors suggest that these supportive aspects are transferable to other multi-disciplinary team settings.

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.