There are some principles to the psychologically informed community management of personality disordered offenders, which apply to most types of personality disorder. They are summarised in the box below.
First, consider the options for management – personal, external and environmental. By this, we mean, the capacity for personal change by means of therapeutic interventions, anxiety about behaviour and motivation to change; the likely degree of compliance with external controls – such as curfews, exclusions, abstaining from drug use etc; and finally, the possibility that by changing the environment, traits no longer become problematic. An example of the latter case might be the decision to place a paranoid man in his own flat rather than approved premises (despite the seriousness of his offence) because there is less to be paranoid about in his flat.
Second, many personality disordered offenders – particularly those in cluster A (odd) and cluster B (dramatic) are rule-breakers (see table 1.1 chapter 1). This may well be due to impulsivity, or to anti-authoritarian attitudes and beliefs that ‘the rules don’t apply to me’. The intuitive response of any practitioner, when faced with a rule-breaker, is to try and exert more control. This is why licence conditions for personality disordered offenders tend to be longer than most. Unfortunately the drive to break rules is too ingrained, too compelling, this strategy simply provides the individual with more rules to break! Even worse, the practitioner cannot manage too many rules and the plan becomes inconsistently enforced. The recommendation is to act in a counter-intuitive way: cut down the rules to a bare and essential minimum – those which best manage risk – and then enforce them with consistency and rigour. However, it is still important to try and build in some kind of goal system – positively oriented – which allows for encouragement and a sense of progress. As with all behavioural approaches, make sure these goals and the indications of progress are thought out in advance, clear, consistent and easy to achieve.
Third – and we have already covered this – anticipate problems rather than react to them. Develop the attachment understanding, consider the personality traits, and link them to possible patterns of behaviour in the here and now. Having a plan of action in advance is much more likely to succeed, than trying to repair a problem once it has started.
Fourth, a special mention about Local Authority care. Practitioners are often puzzled at the apparently unnecessary and irrational oppositional – sometimes frankly hostile – behaviour shown by some personality disordered offenders. This can even be hurtful when the practitioner is genuinely trying to establish rapport and be of assistance. It is worth checking whether the individual has a history of being placed in care, sometimes fostered but often a children’s home or boarding school. Why might this be relevant? Children want to preserve a sense of having been loved and cared for – it is part of the biological drive to form attachments to caregivers – and will go to great lengths to ensure that no experiences shatter these beliefs. When placed in care, they therefore separate out in their mind their parents (good and loving) from the Local Authority care (indifferent and neglectful) and seek to form links with the other children to undermine the authority of the ‘false parents’. Even in adulthood, it remains important for the individual to believe in the inadequacy and failures of institutions and authority, in order to preserve a shaky belief in their family of origin.
Fifth, think about personality disorder in terms of core and secondary characteristics. This was a model discussed in chapter two, and again in this chapter in relation to Table 4.2. Just to recap, there seems to be evidence that core characteristics do not really change over time – may even be genetically driven – but there is cause for optimism in considering secondary characteristics which appear to mature and to respond to interventions. Furthermore, we know that some situations or interactions directly tap into and provoke core characteristics (such as the paranoid man in approved premises, or Peter provoking his offender manager into trying to persuade him his beliefs are wrong) whilst others are less provocative. As with rule-breaking, practitioners are intuitively drawn to identify and challenge the core characteristics, when paradoxically, these are the very aspects of the individual’s presentation to soothe or avoid.
Finally, when working with a high risk of harm offender, think about prioritising. There is nothing more demoralising than considering a very long list of potentially problematic attitudes and behaviours. It instils despondency in both the practitioner, and in the individual offender who believes that he has been ‘condemned to failure’. There are two ways to prioritise, and we recommend doing both:
In this way, the individual understands exactly where the risk management plan has come from, but is also engaged in a more collaborative approach which values his own agenda as well as that of ‘authority’.