Offender Personality Disorder Pathway Therapies

Individual therapy focuses on building new attachments to process childhood traumas. The therapy aims to develop a secure emotional connection and empathy, which are crucial for feeling safe and maintaining good relationships. Therapy sessions can involve sensorimotor psychotherapy work, imagery and chair work, and incorporate other therapeutic approaches depending on what techniques the therapist deems suitable. These techniques are designed to manage emotional sensitivity to triggers, explore distressing material, and foster healthier responses to threats before addressing prioritised treatment needs based upon the collaborative formulation developed before the start of therapy.  

The goals of individual therapy include establishing a containing relationship, developing ways to access and manage emotions, processing trauma, understanding one's earlier self, reducing sensitivity to trauma triggers, and fostering mindfulness of personal growth. This therapy also seeks to address the roots and motivations of offending behaviours and support the development of healthier coping mechanisms which should address risk.

This group therapy aims to help participants understand and challenge repetitive behaviours stemming from unhelpful core beliefs. The group encourages participants to identify these core beliefs and support them in the journey towards change.

The primary objectives of the Schema Group include:

1. Understanding what schemas and schema modes are.
2. Discovering the childhood origins of schemas and modes, and the ways these are  perpetuated.
3. Understanding the link between schemas, schema modes, personality, and offending behaviour.
4. Weakening and healing unhealthy schemas and changing unhelpful mode behaviour.
5. Developing and reinforcing healthy schemas and a healthy adult mode.

The Schema Group employs a combination of methods: psychoeducation (educational approach to understand psychological concepts), experiential exercises (practical exercises to comprehend your responses and process earlier traumas), and formulation (enhancing your understanding of how schemas relate to your thoughts, emotions, and beliefs).

The Identity and Integration Group (IIG) focuses on the impact of early life experiences on an individual's identity, their relationship patterns, and their expectations of themselves.

This group therapy is designed to build upon the work completed in the Schema Group, which helps clients understand and process the effects of traumatic experiences. It further advances the formation of the "healthy adult" identity through experiential exercises and promotes lasting change through consistent exposure to new experiences.

The IIG works to strengthen participants' new identities, providing them with the resilience to handle experiences that might trigger negative emotions like shame or humiliation. By understanding their past offensive behaviours better, individuals can respond to triggering events more predictably and positively.

The main focus of the IIG is to aid participants' transition by helping them comprehend their new identity and how it can contribute to personal and societal safety.

The primary aims of the IIG are to:

1. Understand what identity means.
2. Explore how an individual's identity has been shaped.
3. Work towards a single identity that aligns with how others perceive the individual.
4. Enable individuals to be their genuine selves in different environments.
5. Identify and strengthen desired aspects of the individual's identity.
6. Maintain focus on the new identity and ensure consistent behaviour.
7. Understand how the past identity has been linked to risk.
8. Understand how changes to the individual's identity can reduce risk and support a life free from offending.

The Relational Group is an unstructured group therapy that starts 18 months into the 24-month Schema group therapy program. This approach is designed for individuals who might find it challenging to be part of a larger group but need to address engaging in wider interpersonal groupings to help them develop skills in healthy relating to others.

This is a rolling group, meaning it may include individuals who were not in the original Schema group and who may be at different stages in their treatment. This dynamic is designed to offer participants more opportunities to develop relationships in preparation for their departure from The Fens. The group will consist of no more than eight members.

The group's aim is to create a safe environment for exploring group dynamics and focusing on emotional intimacy, inclusivity, and modifying behaviours that might prevent others from getting to know the individual. It encourages open and honest feedback to foster growth, conflict resolution, and self-understanding.
The main goals of the Relational Group are:

1. Help members recognise commonalities with others.
2. Enable further development and strengthening of relationships among group members.
3. Show how emotional support can be an effective tool for managing emotions.
4. Encourage members to take emotional responsibility for their past and present unhealthy behaviours.
5. Challenge members' distorted beliefs about themselves and the world.
6. Teach members to resolve conflicts healthily.
7. Help members recognise their positive contributions to interpersonal relationships.
8. Enable members to take responsibility for and understand the process of parallel offending.

Fens Treatment + acknowledges that every individual has unique needs and may require a tailored treatment approach. In an effort to respond appropriately to these varying needs, the team has implemented this treatment option.

During the formulation process, the team will discuss with you whether FensTreatment + is suitable based on your specific needs. While you will still go through the same treatment phases as others, the pace of delivery will be slower and more active. Additionally, your therapy groups may be smaller, and you will receive an extra support session, allowing for more personalised and focused care.

Short term affect interventions are intended for individuals struggling with issues such as anger, self-harm, trauma flashbacks, and suicidal thoughts. These sessions are time-limited and supplemental to regular therapy. They are offered on an individual need’s basis realising not all service users will need this intervention. It is not intended as a continuous provision but to allow an additional intervention to the service user to enable core therapy to recommence or be supported where aspects of destabilisation are impacting upon effective therapeutic engagement.

CPFT recognise that Staff Health and Wellbeing is intrinsically linked to staff morale and engagement.  Happy and well staff result in better and safer services. Wellbeing is a subjective experience comprising many inter-linked aspects such as job satisfaction, positive and negative responses and feelings, levels of motivation emotional exhaustion and burnout.  Therefore, our approach is to work on all aspects of wellbeing from organisational enablers such as compassionate and inclusive leadership, management, facilities, and environment, through to supportive and clear HR policies and health interventions to keep staff well and at work.

How we look after our staff:

Proactive wellbeing interventions made available to staff include:

• Internal Staff Wellbeing Service (established 2018)
• Occupational Therapy
• Eight-week mindfulness-for-life course
• Swift access to physiotherapy
• Self-help material
• Employee Assistance Programme
• Promote and utilise integrated care services available for our staff including Staff Mental Health Service and Staff Support Hub.
• Schwartz Rounds available (provide safe space to share experiences of emotional or psychological aspects of working in healthcare). 
• Heart and Soul Volunteers
• Supporting Attendance Policy (2021) introducing wellbeing at work passport and Stress at Work Risk Assessments
• Wellbeing Wednesday newsletter publications
• Menopause Policy and established support group­­

Flexible working and blended working patterns are available to support staff. Pre-existing support structures, such as good quality supervision are utilised to support individuals and teams, with additional sessions being made available when necessary. Regular planned breaks in therapy allow staff time to decompress and engage in training and continued professional development.

We create supportive working environments and offer coaching to empower staff and enhance their involvement in all areas to increase job satisfaction and happiness at work.  We provide wellbeing support and reflective spaces for managers and leaders as they have a responsibility in ensuring the wellbeing of their teams but will not be able to perform this role if they are not well themselves.  We provide training for all managers to promote and develop compassionate leadership across CPFT encourage active interest and involvement in their staff and create hope and role-model positive coping behaviours. 

Team building

We highly value and encourage team-building activities and appreciate their impact on wellbeing.  Our team has regular team-building and wellbeing away days, team connecting events, and out-of-work activities which are enjoyable and well appreciated by the team.

For further information about the Fens services or events please contact:

• Jacquie Evans –Clinical Lead (CPFT) email: jacquie.evans@cpft.nhs.uk
• Daniel Flack – Head of Function (HMPPS) email: daniel.p.flack@justice.gov.uk
• Siobhan O'Kane- Service Manager (CPFT) email: siobhan.okane@cpft.nhs.uk 

Below are quotes from previous service users: 

“It’s taken me to get my life sentence to be able to free myself”

“What I got out of treatment is like I no longer hide my shame. I've talked about my shame and I have self worth and I have a future."

"And every one-to-one was a different kind of experience because they took me to a different place… further on in the process."

"I do actually believe that doing this treatment has given me my life back.”

We have a large multi-skilled clinical team comprising psychologists, psychotherapists, nurse therapists, psychiatrists, assistant psychologists and applied trainee psychologists.  The team is led by a clinical lead supported by a service manager in co-ordination with prison officers.

Check out all the latest vacancies within CPFT in our jobs area here: Latest vacancies | CPFT NHS Trust