women and personality disorder (or why women aren’t just funny shaped men)...
TRANSCRIPT
focuson women who are harmful to themselves
and/or others most likely because of personality difficulties
women with personality disorder
• what’s different about women?• what’s different about working with women?• the offender PD pathway and the rivendell
service
what’s different …about women with personality disorder
1. gender has an influence on the behaviour of others, and on our expectations about their behaviour
Paris (2007)Rosenfield (2000)
greateridentification
with peers
greateridentification
with intimates
2. the harmful behaviour of men is broadly consistent with our expectations
3. the harmful behaviour of women is more complex …
Adshead (2011)
Adshead (2011)
held accountable,
withoutquestion
responsibility‘neutralised’
“it appears self-evident that the power one holds in the domain in which one holds it will influence the method used to abuse that power to the detriment of others”
Logan, C. & Weizmann-Henelius, G. (2012). Psychopathy in women: Presentation, assessment and management. In H. Häkkänen-Nyholm & J.O. Nyholm (Eds), Psychopathy and Law. Chichester: Wiley
Blackwell.
4. the harmfulness of women is different from that of men
5. to treat women like (funny shaped) men is to risk overlooking information of importance to interventions
6. to treat women like you would treat men – as if they were interchangeable – runs the risk of underestimating harm potential because that potential is either misunderstood, neutralised (e.g., she’s mentally ill, she’s a victim) or minimised (e.g., low risk of physical harm)
7. therefore, assessments and interventions that reflect the behaviour of men (e.g., the PCL-R) – one’s expectations about men – and underplay the social context of harmful behaviour, will have limited utility with women
8. gender influences the expression of the same underlying traits
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“mirror image disorders” (Paris 1997):•“… similar traits in men and women can have different behavioural expression. The same underlying dimensions could lead to different forms of psychopathology in the two genders … impulsivity in men is more likely to be expressed through exploitation of others, whereas impulsivity in women is more likely to be expressed in self-destructive behaviours.”
what’s different …
about working with women with personality disorder
essentials
• focus on the problems, experiences, and responses of women – as opposed to those of men
• reliance upon a practitioner group (a) dedicated to and (b) experienced in working with (c) women with personality disturbance
• implementing treatment and management practices developed for women– as opposed to adapting those developed for men
essentials
• relationships paramount– individual (peer, professional)– group (peer, professional)– the ‘scurvey behaviour of women’ Atwood (1984)
• therefore, focus on relational security
essentials
• a practitioner group that is informed about women and personality disorder– for whom individual and group supervision are
essential rather than a luxury
• clarity of purpose• good – containing, validating, empathic and
supportive – leadership
interventions
• support to find, manage, and maintain suitable accommodation
• financial security• understanding obstacles to change (inc.
reintegration after detention) faced by women – and working to reduce these as far as possible
interventions
• pro-social modelling and positive staff interactions
• stabilisation of drug and alcohol, and co-occurring mental health problems
• improved literacy, numeracy, and other essential life skills
• facilitating family contact for women in detention
interventions
• cognitive skills programmes to address impulsivity and poor problem solving for women at greater risk of harmful behaviour– address criminogenic need
interventions
• for those, at greatest risk, multi-modal programmes, integrating CBT interventions addressing problem-solving, emotional management, assertiveness, and negotiation combined with practical help in terms of money and time management, parenting, negotiation and employment skills, and so on• a higher ‘dose’ of treatment
targets
• poor self-awareness and lack of a sense of identity
• inability to ‘read’ other people or think about (‘mentalize’) others’ wishes, beliefs and intentions– a tendency to respond to them as if they are
abusive, cruel and exploitative figures from the past
targets
• chronically high levels of anxiety and arousal that cannot be easily managed
• extreme sensitivity to rejection, experiences of shame, and perceived humiliation
• little sense of being able to influence the direction of their own lives, which then become experienced as fragmented and lacking in purpose or meaning
the rivendell service
and the Offender Personality Disorder Pathway for women
offender personality disorder strategy
• 2011 on• successor to the DSPD Programme• Nick Joseph and Nick Benefield• establishment of pathways of variable ‘dose’
interventions and support across prison and probation services that addresses the needs of high risk men and women with personality disorder
offender personality disorder strategy
• for offenders who …– have a current offence of serious harm and are
likely to be serving determinate sentences– are likely to have a severe form of personality
disorder – are assessed as presenting a high risk of
committing a further serious offence– there is a clinically justifiable link between
personality functioning and future risk
offender personality disorder strategy
higher level outcomes
the rivendell service
• a pathway service for women• HMP New Hall, West Yorkshire
• focus on helping women to manage safely and in a prosocial way strong feelings and beliefs about themselves and others arising from early distressing experiences and relationships
• training and staff support is geared towards quality of relationships and relational security
mentoring and advocacy (TWP)
the pathway
the clinical model
STRUCTURED
LESSSTRUCTURED
safety
containment
control + regulation
exploration + change
integration + synthesis
safety & containment
practical skills(control & regulation)
beliefs & attitudes(exploration & change)
lifestyle & resettlement(integration & synthesis)
gender sensitive
assessment &
(re)formulation
safety & containment
practical skills(control & regulation)
beliefs & attitudes(exploration & change)
lifestyle & resettlement(integration & synthesis)
gender sensitive
assessment &
(re)formulation
especially self-harm
and violence
safety & containment
practical skills(control & regulation)
beliefs & attitudes(exploration & change)
lifestyle & resettlement(integration & synthesis)
gender sensitive
assessment &
(re)formulation
practical skills
• emotion management/regulation• tolerating strong & cycling emotions• understanding triggers emotions• interpersonal problem solving skills• critical reasoning• responsible sensation-seeking• goal-setting• impulse control• assertiveness
safety & containment
practical skills(control & regulation)
beliefs & attitudes(exploration & change)
lifestyle & resettlement(integration & synthesis)
gender sensitive
assessment &
(re)formulation
integrated
therapy
safety & containment
practical skills(control & regulation)
beliefs & attitudes(exploration & change)
lifestyle & resettlement(integration & synthesis)
gender sensitive
assessment &
(re)formulation
family, home,
finance, stability
CARE Programme
Together Women Project
service user
involvement
women with personality disorder
• what’s different about women?• what’s different about working with women?• the offender PD pathway and the rivendell
service
