An empirical evaluation of reasons for non‐completion of treatment in a dangerous and severe personality disorder unit
- 24 March 2010
- journal article
- research article
- Published by Wiley in Criminal Behaviour and Mental Health
- Vol. 20 (2), 129-143
- https://doi.org/10.1002/cbm.760
Abstract
Background Individuals deemed to be of high risk to others, and diagnosed with severe personality disorders have become the focus for developing clinical services in England. Such services often require highly secure accommodation and labour-intensive therapeutic interventions. There is, however, uncertainty about the capacity to engage such patients effectively in therapies. Aim Here, we examine service evaluation monitoring data to identify the level of completion of therapeutic programmes in a high secure severe personality disordered population, and analyse reasons for failure to complete. Method Guidelines for classifying reasons for non-completion were developed, based on the multifactorial offender readiness model (MORM). Electronic case notes were searched for references to non-completion, and recorded reasons for non-completion were classified. Results Non-completion was at a relatively modest level. The main reasons for non-completion were: (1) affective: general distress of the patient or specific emotional reactions to previous offending, e.g. shame; (2) volitional: pursuing goals other than treatment; and (3) cognitive: negative self-efficacy beliefs and negative evaluations (low trust) of staff and the programme. External factors included exclusion from treatment and transfer to another unit. Conclusion This study identifies specific readiness areas that might need to be addressed in efforts to improve engagement and retention in treatment. A wider range of methodologies is required for future studies. Copyright © 2010 John Wiley & Sons, Ltd.This publication has 25 references indexed in Scilit:
- Engagement and retention in specialist services for people with personality disorderActa Psychiatrica Scandinavica, 2009
- The Function of Aggression in Personality Disordered PatientsJournal of Interpersonal Violence, 2008
- Assessing Treatment Readiness in Violent OffendersJournal of Interpersonal Violence, 2008
- Assessing Suitability for Offender RehabilitationCriminal Justice and Behavior, 2007
- Challenges in the treatment of dangerous and severe personality disorderAdvances in Psychiatric Treatment, 2007
- What's the point? Towards a methodology for assessing the function of psychiatric inpatient aggressionBehaviour Research and Therapy, 2007
- Offender Treatment Attrition and its Relationship with Risk, Responsivity, and RecidivismCriminal Justice and Behavior, 2002
- Early termination of treatment in personality disorder treated in a psychotherapy hospitalThe British Journal of Psychiatry, 2000
- Predictors of Sex Offender Treatment CompletionJournal of Child Sexual Abuse, 1999
- Survey of attendance at a community-based anger control group treatment programme with reference to source of referral, age of client and external motivating featuresJournal of Mental Health, 1997