Location of Repository

The needs of staff who care for offenders with a diagnosis of personality disorder: an organisational case study

By Arabella Kurtz


Individuals with a diagnosis of personality disorder who are considered a risk to others are a current concern for healthcare providers, the government and society. Service provision for this group has recently increased, making it especially important to learn about the needs of staff who care for these demanding and complex individuals. Little research has been done in this area to date. The theoretical and empirical literature relevant to a consideration of the topic is reviewed. An in-depth interview study with staff working in a unit for offenders with a diagnosis of personality disorder (Unit Z) is presented. Its purpose was to develop understanding of the needs of staff who work with individuals with a diagnosis of personality disorder who are judged to be a risk to others. An eventual aim was to inform an intervention with staff, which could then be evaluated.\ud Twelve in-depth interviews were carried out with multi-disciplinary staff from Unit Z. These were analysed according to the grounded theory method (Strauss & Corbin, 1998; Charmaz, 2003). An interview with a community practitioner from a different service was carried out to enhance thinking about the effects of setting. Four Unit Z patients were randomly selected to participate in a group discussion to test initial findings and integrate their perspectives into the study. Main categories were generated from analysis of the data, and a core category was identified entitled `Risk of Isolation'.\ud Further categories were divided into `Areas of Concern' and `Key Contextual Factors' and a model was developed. This is discussed in relation to the existing literature. Implications for an understanding of the needs of staff who care for this patient group are outlined. Recommendations include: the provision of individual and group supervision to help staff reflect on the personal impact of the work, and the way in which staff relationships are affected by contact with the patient group; a focus by service heads on recruiting staff who are able to offer stability and understanding to patients and on retaining experienced workers; and the development of links with agencies for onward referral. Suggestions are made for future research and practice, with particular reference to the profession of clinical psychology. The importance of investigating the influence of changes in practice on long-term therapeutic outcome is emphasized

Publisher: University of Leicester
Year: 2004
OAI identifier: oai:lra.le.ac.uk:2381/7766

Suggested articles



  1. (1997). (lids) Alultiple Voices: Narrative In Systemic Therapy.
  2. (1962). 1Icalth as transccndcncc of cnvironmcnt'.
  3. (1997). A failure of function: teamwork in primary health care'. doi
  4. (1996). A Legal Perspective'. In
  5. (1995). A Mcta"Analytic Asscssmcnt or Delinquency-Related Outcomes of Alternative Education Programs'. Crime and Delinquency, doi
  6. (1998). A phcnomologicel study of vicarious trnunnntis3tion amongst psychologists and professional counsellors working in the field of sexual abuse/assault'.
  7. (2002). A Psychoanalytic Vicw of Two I'orcnsic Mental I Icalth Services'.
  8. (1979). A scaled version of the Gcncrul health Questionnaire'. doi
  9. (1996). A Supervisor's View'. In doi
  10. (1985). An adult attachment Interview Interview protocol. Unpublished manuscript:
  11. (1990). An Incrcasc in Violence on an Acutc Psychiatric Ward: A Study of Associated Factors'.
  12. (1999). Antisocial personality disorder; An ej; idcnmlologlcal pcrspectlvc.
  13. (2001). Attachment in mental health institutions: A critical rcvicw of assumptions, clinical implications and research strategies'. Attachment d Human Development, doi
  14. (1994). Authority, power and leadership: contributions from group rclations training'.
  15. (1998). Basics ºof Qualitative Research: Techniques and Procedures for Developing Grounded Theory (Second Edition). doi
  16. (1998). Charactcristics of consultant forcnsic psychiatrists (a modest survcy)'.
  17. (2001). Dctcrminants of job satisfaction in psychologists'.
  18. (1997). Developing Models for Managing Treatment Integrity and l: flicacy in a Prison-based TC: The Max Glatt Centro'.
  19. (2002). Developing services for people with dangerous and severe personality disorders'. doi
  20. (1996). Diagnosis of Personality Disordcr: A Radical Bchavioral Altcmativc'.
  21. (1994). Diverting Children from a Life of Crime: Measuring Costs and Benefits. doi
  22. (1999). Effective treatment relationships for persons with serious psychiatric disorders: The importance of attachment states of mind'. doi
  23. (1999). Effectiveness of Psychotherapy for Pcrsonality Disorders'.
  24. (2001). Enhancing the Rigor of Grounded Theory: Incorporating Reflexivity and Relationality'. doi
  25. (1961). Experiences in Groups. doi
  26. (1997). From action to thought: supervising mental health workers with forcnsic paticnts'.
  27. (2002). From passive subjects to equal partncrs: Qualitative review of user involvement in research'. doi
  28. (1997). Job satisfaction and Burnout among members of community mental health teams'. doi
  29. (1991). Learning from the Patient. doi
  30. (1993). Locked in role: a psychotherapist within the social defence system of a prison. doi
  31. (2002). Managing the unmanageable: psychotherapy in Qrcndon Prison'. doi
  32. (1997). Maslach Burnout Inventory: Third Edition'. In doi
  33. (1949). Mate in the Countcrtransference'. In Collected Papers: Through Paediatrics to Psychoanalysis. doi
  34. (2002). Mental health, 'burnout' and job satisfaction in a longitudinal study of mcntal health staff'. Social Psychiatry and Psychiatric Epldcmlolog -, doi
  35. (1995). Multisystcmic Treatment of Serious Juvenile Offenders: Long-term Prevention of Criminality and Violence'. doi
  36. (1946). Notes on some schizoid mcchanisms'.
  37. (2002). Occupational stress, work satisfaction and health among the helping professions'.
  38. (1961). On the Characteristics of Total Institutions'.
  39. (1953). On the Dynamics of Social Structure'.
  40. (1998). Outcome of Personality Disorders'. doi
  41. (1994). Pain tolerable and intolerable: consultations to two staff groups who work in the face of potentially fatal illness'. In
  42. (1994). Personality disorders and violence'. doi
  43. (1994). Psychiatric Disorder in VVomcn Scrving a Prison Sentence. doi
  44. (1998). Psychiatric staff as attachment figures'. doi
  45. (1995). Psychological stress in the %yorkplace'.
  46. (2002). Psychopathy and thcrapcutic pessimism: Clinical lore or clinical reality? ' doi
  47. (1999). Public inquiries in mental health (with particular reference to the Blackwood case at Broadmoor and the patient complaints of Ashworth Hospital.
  48. (2002). Pure Macm ess: how Fear Drives Tue , 1(ental flealtlt System. Kings Fund Lecture; Faculty of Public Health Medicine Annual Scicntific Confcrcnce.
  49. (2003). Reflecting on reflection'.
  50. (2001). Reform of the Mental Health Act: Implications for Clinical Psychologists'.
  51. (1998). Report of the Network on Staff Support and Interventions. High Security Psychiatric Services Commissioning Board Personality Disorder Networks. Department of Health.
  52. (1999). Response to the Government Discussion I'aper "Managing Dangerous People with Severe Personality Disorder" - Proposals for Development.
  53. (1985). Security in infancy, childhood and adulthood: A move to the lcvcl of represcntation'.
  54. (1955). Social Systems as a defence against Persecutory and Depressive Anxicty'.
  55. (1955). Social systems as a defence against persecutory and depressive anxiety.
  56. (1960). Social Systems as n Defense Against Anxiety: An Empirical Study of the Nursing Service of a General hospital'. doi
  57. (1979). Staff support systems: task and anti-task in adolescent institutions'.
  58. (2001). Stop and think! ': Social problem-solving therapy with { rsonality disordered ofcndcrs'.
  59. (1999). Stress and emotion. A new synthesis, doi
  60. (2000). Tands in special (high security) hospitals'.
  61. (1990). Task and Sentient Systems and Their Boundary Controls'.
  62. (1994). Tbc evolution of s concept: aggression and violcncc in psychiatric settings'.
  63. (2000). Team working and effectiveness Commission for Health Improvement doi
  64. (1998). The Adolescent Separation Anxiety Interview, Unpub! ishcd intcrvicw protocol: Goldsmiths College,
  65. (1968). The ailment. doi
  66. (2004). The Contribution of Cognitive Analytic Therapy to the Treatment of Borden Inc Personality Disorder'.
  67. (2002). The distinction between personality disorder and mental illness'. doi
  68. (2003). The Imaginative Body. London: Whurr Publishers Ltd, National Instituts for Mcntal I Icalth in
  69. (1995). The relationship betwccin n medium secure environment and occupational stress in forcnsic psychiatric nurses'.
  70. (1994). The relevance of psychotherapy. doi
  71. (1999). The Report of the Committee of Inquiry into the Personality Disorder Unit, Ashworth Special Hospital. London: Stationery Office.
  72. (1997). The role of attachment in therapeutic relationships'.
  73. (1994). The unconscious at work in groups and teams: contributions from the work of Wilfred Bion. ' In
  74. (1996). theory: practical implcmcntation'. In
  75. (1999). Therapeutic Community 19! Ctivenesc; A Systematic International Review of Therapeutic Community Treatment for People with Personality Disorders And Mentally Disordered Offenders. School of Socuogy and Social Policy,
  76. (2004). Thinking under Fire: The Challenge for Forensic Mental I icalth
  77. (2002). Three degrees of security: attachment and forensic institutions'. doi
  78. (2002). Tic institutionalization of n concept'. doi
  79. (1996). Transfercnce and Countertransfcrence: ßcncral and Forensic Aspects'. In'
  80. (2000). Trcatmcnt of Antisocial Personality, Psychopathy, and other Charactcrologic Antisocial Syndromes', doi
  81. (2001). Trcatmcnt of personality disorders'.
  82. (1984). Treatment outcome in personality disorder: the effect of social, psychological and behavioural variables'. doi
  83. (1998). u Role of Individual Fcaturcs'.
  84. (1999). Vicarious traumatisation of counsellors and cl%cts on their workplaces'. doi
  85. (1990). Violcncc and Social Structurc on Mental Hospital Wards'.
  86. (2002). Violence and Mental Disorder: A Critical Aid to the Assessment and Management of Risk London & Philadelphia: Jcssica Kingslcy Publishers.
  87. (1991). Violence by psychiatric inpatients: A revicw'. doi
  88. (2003). Violent incidents and staft'stress'.
  89. (1974). Ward atmosphere scale manual, doi
  90. (1994). What events precede violent incidents in psychiatric hospitals? ' doi
  91. (2002). What works for delinquency: A review of studies of interventions for young offenders'.
  92. (1995). What Works: Past, Present and Futurc'. In
  93. (2004). Working Together: Integrated Multidisciplinary Practice with Women. ' In
  94. (1992). World Health Organization doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.