Treatment Alternatives for Mentally Disordered Offenders:A Literature Review
Joshua J. Knabb, Robert K. Welsh, Marjorie L. Graham-Howard
DOI: 10.4236/psych.2011.22020   PDF    HTML     10,062 Downloads   19,282 Views   Citations


Over the last few decades, a considerable amount of research has been devoted to mentally disordered offenders, with both theoretical and empirically validated treatments permeating the literature. Due to the recent onslaught of treatment options for MDOs, a synthesis of this literature seems immediately relevant to the field of forensic psychology. The authors review the current status of the treatment literature for both sentenced and nonsentenced MDOs in both inpatient and outpatient settings. An exhaustive search of the available literature on MDO treatment options was conducted. Ten treatment modalities, both theoretical and empirically validated, were summarized, including their theoretical underpinnings, interventions, empirical support, and strengths and weaknesses. Issues surrounding future research are also discussed.

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Knabb, J. , Welsh, R. & Graham-Howard, M. (2011). Treatment Alternatives for Mentally Disordered Offenders:A Literature Review. Psychology, 2, 122-131. doi: 10.4236/psych.2011.22020.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Adler, G. (1982). Recent psychoanalytic contributions to the understanding and treatment of criminal behavior. International Journal of Offender Therapy and Comparative Criminology, 26, 281-287. doi:10.1177/0306624X8202600311
[2] Auld, F., Hyman, H., & Rudzinski, D. (2005). Resolution of inner conflict: An introduction to psychoanalytic therapy. Washington, DC: American Psychological Association. doi:10.1037/11084-000
[3] Blud, L., & Travers, R. (2001). Interpersonal problem-solving skills training: A comparison of R & R and ETS. Criminal Behavior and Mental Health, 11, 251-261. doi:10.1002/cbm.399
[4] Burns, B., & Santos, A. (1995). Assertive community treatment: An update of randomized trials. Psychiatric Services, 46, 669-675.
[5] Case, C., & Dalley, T. (2006). The handbook of art therapy (2nd ed.). New York, NY: Routledge.
[6] Clarke, A., & Ndegwa, D. (2006). Forensic personality disorder in an MSU: Lessons learned after two years. British Journal of Forensic Practice, 8, 29-33.
[7] Cooke, M., & Cooke, G. (1982). An integrated treatment program for mentally ill offenders: Description and evaluation. International Journal of Offender Therapy and Comparative Criminology, 26, 53- 61. doi:10.1177/0306624X8202600109
[8] Cowmeadow, P. (1994). Deliberate self-harm and cognitive analytic therapy. International Journal of Short-Term Psychotherapy, 9, 135- 150.
[9] Duignan, I., & Mitzman, S. (1994). Measuring individual change in patients receiving time-limited cognitive analytic group therapy. International Journal of Short-Term Psychotherapy, 9, 151-160.
[10] Evershed, S., Tennant, A., & Boomer, D. (2003). Practice-based outcomes of dialectical behaviour therapy (DBT) targeting anger and violence with male forensic patients: A pragmatic and non-contemporaneous comparison. Criminal Behaviour and Mental Health, 13, 198-213. doi:10.1002/cbm.542
[11] Feder, E., & Feder, B. (1981). The expressive art therapies. Englewood Cliffs, NJ: Prentice-Hall, Inc.
[12] Fleck, D., Thompson, C., & Narroway, L. (2001). Implementation of a problem solving skills training programme in a medium security unit. Criminal Behaviour and Mental Health, 11, 262-272. doi:10.1002/cbm.400
[13] Fruzzetti, A. (2002). Dialectical behavior therapy for borderline personality and related disorders. In F. Kaslow & T. Patterson (Eds.), Comprehensive Handbook of Psychotherapy: Cognitive-Behavioral Approaches. Hoboken, NJ: John Wiley & Sons, Inc.
[14] Golynkina, K., & Ryle, A. (2000). Effectiveness of time-limited cognitive analytic therapy of borderline personality disorder: Factors associated with outcome. British Journal of Medical Psychology, 73, 197-210. doi:10.1348/000711200160426
[15] Goodness, K., & Renfro, N. (2002). Changing a culture: A brief program analysis of a social learning program on a maximum-security forensic unit. Behavioral Sciences and the Law, 20, 495-506.
[16] Greeven, P., & De Ruiter, C. (2004). Personality disorders in a Dutch forensic psychiatric sample: Changes with treatment. Criminal Behaviour and Mental Health, 14, 280-290. doi:10.1002/cbm.594
[17] Hakvoort, L. (2002). A music therapy anger management program for forensic offenders. Music Therapy Perspectives, 20, 123-132.
[18] Hodel, B., & West, A. (2003). A cognitive training for mentally ill offenders with treatment-resistant schizophrenia. The Journal of Forensic Psychiatry & Psychology, 14, 554-568. doi:10.1080/1478994031000152745
[19] Hoffman, K., & Kluttig, T. (2006). Psychoanalytic and group-analytic perspectives in forensic psychotherapy. Group Analysis, 39, 9-23. doi:10.1177/0533316406062321
[20] Holmes, J. (2001). The search for the secure base: Attachment theory and psychotherapy. Philadelphia, PA: Taylor & Francis Inc.
[21] Jones, D., & Hollin, C. R. (2004). Managing problematic anger: The development of a treatment program for personality disordered patients in high security. International Journal of Forensic Mental Health, 3, 197-210.
[22] Kennard, D. (2004). The therapeutic community as an adaptable treatment modality across different settings. Psychiatric Quarterly, 75, 295-307. doi:10.1023/B:PSAQ.0000031798.95075.26
[23] Lamberti, J., Weisman, R., & Faden, D. (2004). Forensic assertive community treatment: Preventing incarceration of adults with severe mental illness. Psychiatric Services, 55, 1285-1293. doi:10.1176/
[24] Liebmann, M. (1998). Art therapy with offenders. London: Jessica Kingsley Publishers.
[25] Linehan, M., Armstrong, H., Suarez, A., & Allmon, D. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060-1064.
[26] Lipton, D., Pearson, F., Cleland, C., & Yee, D. (2002). The effects of therapeutic communities and milieu therapy on recidivism: Meta- analytic findings from the correctional drug abuse treatment effectiveness (CDATE) study. In J. McGuire (Ed.), Offender Rehabilitation and Treatment: Effective Programmes and Policies to Reduce Re-offending. John Wiley & Sons, Ltd.
[27] Lipton, D., Pearson, F., Cleland, C., & Yee, D. (2002). The effectiveness of cognitive-behavioral treatment methods on offender recidivism: Meta-analytic outcomes from the CDATE project. In J. McGuire (Ed.), Offender Rehabilitation and Treatment: Effective Programmes and Policies to Reduce Re-offending. John Wiley & Sons, Ltd.
[28] Low, G., Jones, D., & Duggan, C. (2001). The treatment of deliberate self-harm in borderline personality disorder using dialectical behaviour therapy: A pilot study in a high security hospital. Behavioural and Cognitive Psychotherapy, 29, 85-92. doi:10.1017/S1352465801001096
[29] MacKain, S., & Streveler, A. (1990). Social and independent living skills for psychiatric patients in a prison setting: Innovations and challenges. Behavior Modification, 14, 490-518. doi:10.1177/01454455900144006
[30] McCann, R., Ball, E., & Ivanoff, A. (2000). DBT with an inpatient forensic population: The cmhip forensic model. Cognitive and Behavioral Practice, 7, 447-456. doi:10.1016/S1077-7229(00)80056-5
[31] McKendrick, K., Sullivan, C., Banks, S., & Sacks, S. (2006). Modified therapeutic community treatment for offenders with mica disorders: Antisocial personality disorder and treatment outcomes. Journal of Offender Rehabilitation, 44, 133-159. doi:10.1300/J076v44n02_06
[32] McMurran, M., Egan, V., & Ahmadi, S. (1998). A retrospective evaluation of a therapeutic community for mentally disordered offenders. The Journal of Forensic Psychiatry, 9, 103-113. doi:10.1080/09585189808402181
[33] Messina, N., Burdon, W., Hagopian, G., & Prendergast, M. (2004). One year return to custody rates among co-disordered offenders. Behavioral Sciences and the Law, 22, 503-518. doi:10.1002/bsl.600
[34] Ogloff, J., Wong, S., & Greenwood, A. (1990). Treating criminal psychopaths in a therapeutic community program. Behavioral Sciences and the Law, 8, 181-190. doi:10.1002/bsl.2370080210
[35] Peters, R., LeVasseur, M., & Chandler, R. (2004). Correctional treatment for co-occurring disorder: Results of a national survey. Behavioral Sciences and the Law, 22, 563-584. doi:10.1002/bsl.607
[36] Pollock, P., & Belshaw, T. (1998). Cognitive analytic therapy for offenders. The Journal of Forensic Psychiatry, 9, 629-642. doi:10.1080/09585189808405378
[37] Pollock, P. H., & Stowell-Smith, M. (2006). Cognitive analytic therapy applied to offending: Theory, tools and practice. In P. Pollock, M. Stowell-Smith & M. Gopfert (Eds.), Cognitive Analytic Therapy for Offenders: A New Approach to Forensic Psychotherapy. New York, NY: Routledge/Taylor & Francis Group.
[38] Reed, K. (2002). Music therapy treatment groups for mentally disordered offenders (MDO) in a state hospital setting. Music Therapy Perspectives, 20, 98-104.
[39] Renn, P. (2002). The link between childhood trauma and later violent offending: The application of attachment theory in a probation setting. Attachment & Human Development, 4, 294-317. doi:10.1080/14616730210167203
[40] Renwick, S., Black, L., Ramm, M., & Novaco, R. (1997). Anger treatment with forensic hospital patients. Legal and Criminological Psychology, 2, 103-116.
[41] Rice, M. (1983). Improving the social skills of males in a maximum security psychiatric setting. Canadian Journal of Behavioral Sciences, 15, 1-13. doi:10.1037/h0080683
[42] Rice, M. & Chaplin, T. (1979). Social skills training for hospitalized male arsonists. Journal of Behavioral Therapy and Experimental Psychiatry, 10, 105-108. doi:10.1016/0005-7916(79)90083-1
[43] Rice, M., & Harris, G. (1997). The treatment of mentally disordered offenders. Psychology, Public Policy, and Law, 3, 126-183. doi:10.1037/1076-8971.3.1.126
[44] Rice, M., Harris, G., & Cormier, C. (1992). An evaluation of a maximum security therapeutic community for psychopaths and other mentally disordered offenders. Law and Human Behavior, 16, 399- 412. doi:10.1007/BF02352266
[45] Rice, M., Quinsey, V., & Houghton, R. (1990). Predicting treatment outcome and recidivism among patients in a maximum security token economy. Behavioral Sciences and the Law, 8, 313-326. doi:10.1002/bsl.2370080312
[46] Rich, P. (2006). From theory to practice: The application of attachment theory to assessment and treatment in forensic mental health services. Criminal Behaviour and Mental Health, 16, 211-216. doi:10.1002/cbm.629
[47] Riches, C. (1998). The hidden therapy of a prison art education programme. In M. Liebmann (Ed.), Art Therapy with Offenders (pp. 77-101). London: Jessican Kingsley Publishers.
[48] Robins, C., & Chapman, A. (2004). Dialectical behavior therapy: Current status, recent developments, and future directions. Journal of Personality Disorders, 18, 73-89. doi:10.1521/pedi.
[49] Ross, S., Fabiano, E., & Ewles, C. (1988). Reasoning and rehabilitation. International Journal of Offender Therapy and Comparative Criminology, 32, 29-36. doi:10.1177/0306624X8803200104
[50] Rubin, J. (2001). Approaches to art therapy: Theory and technique. New York, NY: Brunner-Routledge.
[51] Ryle, A., & Fawkes, L. (2007). Multiplicity of selves and others: Cognitive analytic therapy. Journal of Clinical Psychology, 63, 165-174. doi:10.1002/jclp.20339
[52] Smeijsters, H., & Cleven, G. (2006). The treatment of aggression using arts therapies in forensic psychiatry: Results of a qualitative inquiry. The Arts in Psychotherapy, 33, 37-58. doi:10.1016/j.aip.2005.07.001
[53] Spiegler, M. D. (1983). Contemporary behavioral therapy. Palo Alto, CA: Mayfield Publishing Company.
[54] Steiman, M., & Dobson, K. (2002). Cognitive-behavioral approaches to depression. In F. Kaslow & T. Patterson (Eds.), Comprehensive Handbook of Psychotherapy: Cognitive-Behavioral Approaches. Hoboken, NJ: John Wiley & Sons, Inc.
[55] Teasdale, C. (1997). Art therapy as part of a group therapy programme for personality-disordered offenders. International Journal for Therapeutic and Supportive Organizations, 18, 209-221.
[56] Timmerman, I., & Emmelkamp, P. (2005). The effects of cognitive-behavioral treatment for forensic inpatients. International Journal of Offender Therapy and Comparative Criminology, 49, 590-606. doi:10.1177/0306624X05277661
[57] Timmerman, I., & Emmelkamp, P. (2006). The relationship between attachment styles and cluster b personality disorders in prisoners and forensic inpatients. International Journal of Law and Psychiatry, 29, 48-56. doi:10.1016/j.ijlp.2005.04.005
[58] Udechuku, A., Olver, J., & Hallam, K. (2005). Assertive community treatment of the mentally ill: Service model and effectiveness. Astralasian Psychiatry, 13, 129-134.
[59] Unkefer, R. (1990). Music therapy in the treatment of adults with mental disorders. New York, NY: Schirmer Books.
[60] Van Ijzendoorn, M., Feldbrugge, J., Derks. F., De Ruiter, C., Verhagen, M., Philipse, M. et al. (1997). Attachment representations of personality-disordered criminal offenders. American Journal of Orthopsychiatry, 67, 449-459. doi:10.1037/h0080246
[61] Van Stelle, K., & Moberg, D. (2004). Outcome data for mica clients after participation in an institutional therapeutic community. Journal of Offender Rehabilitation, 39, 37-62. doi:10.1300/J076v39n01_03
[62] Welsh, R., Ashby, J., Glassmire, D., Love, C., Tavegia, B., & Warke, J. (2004). A qualitative review of evidence based forensic treatments. Unpublished manuscript.
[63] Wilson, B. (1990). Music therapy in hospital and community programs. In R. Unkefer (Ed.), Music Therapy in the Treatment of Adults with Mental Disorders. New York, NY: Schirmer Books.
[64] Wix, S. (2003). Dialectical behaviour therapy observed. British Journal of Forensic Practice, 5, 3-8.

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