Lost in translation? Psychometric properties and construct validity of the English Essen Climate Evaluation Schema (EssenCES) social climate questionnaire.

The social climate of correctional (forensic) settings is likely to have a significant impact on the outcome of treatment and the overall functioning of these units. The Essen Climate Evaluation Schema (EssenCES) provides an objective way of measuring social climate that overcomes the content, length, and psychometric limitations of other measures. But the English translation of the EssenCES has yet to be sufficiently validated for use in forensic settings in the United Kingdom. The current study presents psychometric properties (factor structure and internal consistency) and an examination of construct validity with the English EssenCES. Satisfactory internal consistency was found for all EssenCES scales, and the expected three-factor structure was confirmed with both staff and residents and in prison and secure hospital settings using confirmatory factor analysis. Evidence to support construct validity was established using multilevel models, which showed statistically significant associations between scores on the EssenCES and scores on the Working Environment Scale, institutional aggression, and site security. Future validation work and potential practical applications of the EssenCES are discussed.

The role of empathy in anger arousal in violent offenders and university students.

A lack of empathic responsiveness toward others has been consistently identified as an important antecedent to aggressive behavior and violent crime, with many rehabilitation programs for violent offenders incorporating treatment modules that are specifically designed to increase offender empathy. This study examined the extent to which cognitive (perspective taking) and affective (empathic concern, personal distress) empathy predicted anger in a clinical (male prisoners convicted of a violent offense) and a nonclinical (student) sample. Perspective taking emerged as the strongest predictor of self-reported anger in response to an interpersonal provocation, as well as being most consistently related to scores on measures of general trait anger and methods of anger control. While the relationship between perspective taking and anger was apparent for offenders as well as students, the results did not support the idea that an inability to perspective take is a particular characteristic of violent offenders.

The baby, the bathwater and the bath itself: a response to Tyrer et al.'s review of the successes and failures of dangerous and severe personality disorder.

A recent paper by Tyrer et al. in this journal has reviewed the dangerous and severe personality disorder (DSPD) initiative in the assessment and management of severe personality disorder associated with high risk. This previous paper summarized the authors' perceptions of the successes and failures of the DSPD pilot. In the present paper we identify some inaccuracies in the previous review and provide a critique of the conclusions reached.

A systematic review of measures of therapeutic engagement in psychosocial and psychological treatment.

This article reports a systematic review of engagement measures for psychosocial therapy. MEDLINE, EMBASE, and PsycINFO databases were searched to identify English-language studies (published 1980 to February 2010) that reported on an instrument/rating scale to measure engagement in psychosocial treatment for mental health difficulties. Forty-seven studies were identified, reporting information on 40 measures of treatment engagement. Although our findings suggest that therapeutic engagement appears to be considered an important construct to assess, they also reveal that there is little consensus in the definition of engagement employed. Few measures are generalizable across treatment settings and clinical populations, and limited information is reported on the indices of reliability and validity. It is concluded that further work is required to develop adequate measures of therapeutic engagement.

Personality traits as predictors of inpatient aggression in a high-security forensic psychiatric setting: prospective evaluation of the PCL-R and IPDE dimension ratings.

The Dangerous and Severe Personality Disorder (DSPD) initiative in England and Wales provides specialized care to high-risk offenders with mental disorders. This study investigated the predictive utility of personality traits, assessed using the Psychopathy Checklist-Revised (PCL-R) and the International Personality Disorder Examination, with 44 consecutive admissions to the DSPD unit at a high-security forensic psychiatric hospital. Incidents of interpersonal physical aggression (IPA) were observed for 39% of the sample over an average 1.5-year period following admission. Histrionic personality disorder (PD) predicted IPA, and Histrionic, Borderline, and Antisocial PDs all predicted repetitive (2+ incidents of) IPA. PCL-R Factor 1 and Facets 1 and 2 were also significant predictors of IPA. PCL-R Factor 1 and Histrionic PD scores were significantly associated with imminence of IPA. Results were discussed in terms of the utility of personality traits in risk assessment and treatment of specially selected high-risk forensic psychiatric patients in secure settings.

An empirical evaluation of reasons for non-completion of treatment in a dangerous and severe personality disorder unit.

BACKGROUND: Individuals deemed to be of high risk to others, and diagnosed with severe personality disorders have become the focus for developing clinical services in England. Such services often require highly secure accommodation and labour-intensive therapeutic interventions. There is, however, uncertainty about the capacity to engage such patients effectively in therapies. AIM: Here, we examine service evaluation monitoring data to identify the level of completion of therapeutic programmes in a high secure severe personality disordered population, and analyse reasons for failure to complete. METHOD: Guidelines for classifying reasons for non-completion were developed, based on the multifactorial offender readiness model (MORM). Electronic case notes were searched for references to non-completion, and recorded reasons for non-completion were classified. RESULTS: Non-completion was at a relatively modest level. The main reasons for non-completion were: (1) affective: general distress of the patient or specific emotional reactions to previous offending, e.g. shame; (2) volitional: pursuing goals other than treatment; and (3) cognitive: negative self-efficacy beliefs and negative evaluations (low trust) of staff and the programme. External factors included exclusion from treatment and transfer to another unit. CONCLUSION: This study identifies specific readiness areas that might need to be addressed in efforts to improve engagement and retention in treatment. A wider range of methodologies is required for future studies.

Brief anger interventions with offenders may be ineffective: A replication and extension.

Anger-management interventions are widely delivered in the criminal justice and forensic mental health systems. Whilst previous research has generally supported the thesis that anger management is an effective intervention for anger problems in general there remains a need to determine its effectiveness with offender populations. This paper reports the results of a controlled outcome study of a 20 h anger-management program offered to offenders. Those receiving treatment showed improvements in their knowledge about anger, but showed little change on measures of anger and anger expression when compared to waiting-list controls. Scores on measures of treatment readiness and level of need for treatment were however, correlated with post-treatment improvement. These findings are discussed in terms of their implications for the assessment and selection of appropriate participants for offender anger-management programs.

Alcohol-related violence defined by ultimate goals: a qualitative analysis of the features of three different types of violence by intoxicated young male offenders.

Based upon a functional approach to understanding aggression, we aimed to identify the occurrence of and to describe the features of three types of alcohol-related violence defined a priori by ultimate goals: (1) violence in pursuit of nonsocial profit-based goals, (2) violence in pursuit of social dominance goals, and (3) violence as defence in response to threat. A sample of 149 young men with offences of violence that were alcohol related was interviewed. Cases were classified and detailed information from the first ten cases in each class (N=30) was subjected to thematic analysis. Intoxicated violence in pursuit of nonsocial profit-based goals was opportunistic and motivated by the desire for more alcohol or drugs. Violence, in these cases, although serious, appeared to be brief. Intoxicated violence in pursuit of social dominance goals was typically precipitated by past or current insult or injury, and was accompanied by strong anger and an adrenaline rush. Attacks were ferocious, and robbing the victim was not uncommon, perhaps to inflict additional humiliation. Feelings of pride and satisfaction were typical and expressions of remorse were uncommon. Regarding intoxicated violence as defence in response to threat, attacks were often expected, and in some cases the respondent made a pre-emptive strike. Weapon use was common in this group. Fear was experienced, but so too was anger. Feelings of excitement were not reported and remorse was common. Further validation of these types is warranted, and the potential implications of these findings for prevention and treatment are discussed.

The EssenCES measure of social climate: a preliminary validation and normative data in UK high secure hospital settings.

BACKGROUND: The social climate of forensic units is important but little investigated, in part because of the unavailability of a clinically practical and statistically sound measure. AIMS: To provide preliminary psychometric and normative data for the English version of the Essen Climate Evaluation Schema (EssenCES) in UK high-security hospital settings. METHOD: A total of 324 staff and patients from three high-security hospital services completed the EssenCES, and a subgroup completed a range of other questionnaires related to therapeutic milieu and working environment (GMI, WAAM, WES-10). RESULTS: The original three-factor structure and satisfactory internal consistency were retained. The pattern of correlations between the EssenCES scales and other climate-related variables support the construct validity of the EssenCES measure, with the exception of the Patient Cohesion subscale. CONCLUSIONS: Although preliminary, these data suggest that the English version of EssenCES may be a valid tool for assessing the social climate of high secure hospital settings in the UK, but a larger research study is required, covering a wider range of psychiatric disorders, types of service and levels of security.

The function of aggression in personality disordered patients.

It has been suggested that psychological interventions for personality disorders should focus on improving adaptive expression of the functional needs expressed through problematic behaviors such as aggression. The measurement of function is a necessary condition for devising a function-based treatment approach. Two studies that employ a method for assessing the functions of aggressive behavior in personality disordered patients are described by: (a) a retrospective analysis, through file review of inpatient aggressive behaviors and of the index offenses of patients admitted for treatment, and (b) an analysis of inpatient aggressive incidents where staff and patients were interviewed to elicit functions. Results showed that most aggression had the function of expressing anger, although other functions were also evident. The profile of functions observed in the inpatient studies was somewhat dissimilar to that observed in the studies of predominantly psychotic patients. Therapeutic implications of these findings are discussed.

Assessing treatment readiness in violent offenders.

Although violent offenders are widely considered to be difficult to engage in therapeutic change, few methods of assessing treatment readiness currently exist. In this article the validation of a brief self-report measure designed to assess treatment readiness in offenders who have been referred to violent offender treatment programs is described. The measure, which is an adaptation of a general measure of treatment readiness developed in a previous work, displayed acceptable levels of convergent and discriminant validity and was able to successfully predict treatment engagement in violent offender treatment. These results suggest that the measure has utility in the assessment of treatment readiness in violent offenders.

EssenCES, a short questionnaire for assessing the social climate of forensic psychiatric wards.

BACKGROUND: A supportive ward atmosphere is considered by many to be a precondition for successful treatment in forensic psychiatry, but there is a clear need for a valid and economic climate evaluation instrument. AIMS: To validate a short questionnaire, designed for assessing forensic psychiatric wards. Climate dimensions measured with the 'Essen Climate Evaluation Schema' (EssenCES) are 'Therapeutic Hold', 'Patients' Cohesion and Mutual Support' and 'Safety' (versus threat of aggression and violence). METHOD: In 17 forensic mental hospitals in Germany, patients and staff completed the EssenCES and other questionnaires. Problematic events were recorded over a period of 3 weeks on each ward. RESULTS: The anticipated three factor structure of the instrument was confirmed. The pattern of correlations also provided support for the validity of the subscales. CONCLUSIONS: The climate questionnaire is an economic and valid instrument for assessing the ward atmosphere in forensic psychiatry. Findings from a pilot study in England give confidence to the structural validity of the English version too.

Symptoms of trauma, perceptions of discrimination, and anger: a comparison between Australian indigenous and nonindigenous prisoners.

Although the need for the development and provision of culturally appropriate rehabilitation programs for offenders is widely acknowledged, there is a lack of empirical data that can be used as a basis for the development of new programs. This article reports the findings of a comparison of indigenous and nonindigenous male prisoners on a range of measures relevant to the experience of anger by indigenous prisoners in Australia. The results suggest that indigenous participants are more likely to experience symptoms of early trauma, have greater difficulties identifying and describing feelings, and perceive higher levels of discrimination than nonindigenous prisoners. The implications of this work for the development of culturally appropriate and effective anger management programs for indigenous male prisoners are discussed.

What's the point? Towards a methodology for assessing the function of psychiatric inpatient aggression.

There are few examples in the literature of the application of functional analysis to psychiatric inpatient aggression. Structural assessment approaches have dominated. This paper introduces a system for classifying the functions of aggression in psychiatric inpatients that was applied to 502 aggressive behaviours exhibited by patients in a secure forensic psychiatric hospital. At least one function was identified for the majority of aggressive incidents; the most common functions pertaining to patients' responses to the restrictions and demands of the inpatient setting, to express anger or to punish others perceived as provocative, and to maintain status. There was little evidence suggesting that aggression was used to obtain tangible rewards, to reduce social isolation, or to simply observe the suffering of others. Differences in the function of aggressive behaviour were found across victim types. Results of this study have implications for the prediction and prevention of inpatient aggression and for the treatment of aggressive inpatients.

The meaning of anger for Australian Indigenous offenders: the significance of context.

The problem of overrepresentation of Indigenous offenders in Australian prisons highlights the need for effective tertiary intervention programs within correctional settings as a way of reducing Indigenous reincarceration. This study seeks to explore meanings of anger within an Indigenous context that might inform the development of more acceptable and potentially more effective rehabilitation programs. A methodology that acknowledges the importance of narrative, context, and culture was devised to explore how anger as an emotion is understood and experienced by a group of Indigenous men in a South Australian prison. Although some of the major themes reflected experiences of anger common to many offenders, it was evident that for these Indigenous men, anger was experienced within a broad social and political context that imbued the experience of anger with layers of culturally specific meaning. It is suggested that these layers of meaning constitute sufficient difference to warrant further exploration.

Affective determinants of treatment engagement in violent offenders.

Affective factors are likely to play a major role in determining the extent to which offenders are able to engage with, and benefit from, treatment. In this article, it is argued that the relationship between affect and treatment engagement may be understood in three ways: the access the client has to emotional states, the ability to express such states, and the willingness of the client to do this in the therapeutic session. It is suggested that affective determinants of treatment readiness can be understood with reference to models of emotional regulation and that attention to these affective factors in the early stages of treatment is likely to promote engagement, reduce attrition, and consequently improve treatment outcomes for violent offenders.

Alcohol use and negative affect in the offence cycle.

INTRODUCTION: It is commonly acknowledged that, for many offenders, alcohol use is strongly associated with criminal behaviour. The belief held by many professionals that the two phenomena are associated, probably in a causal way, has led to the inclusion of alcohol use as a 'criminogenic need' in many settings where rehabilitation programmes are used to reduce recidivism. However, the mechanisms and pathways involved in the alcohol crime link remain poorly understood. ARGUMENT AND CONCLUSION: This paper reviews the literature relating to alcohol offending links and draws some inferences about the role of alcohol use as a criminogenic need in offender rehabilitation. It is proposed that the bi-directional relationship between alcohol use and negative affective states is important in understanding the offence cycle, and that deficits in self-regulation not only characterize both alcohol misuse and negative affect but are also implicated in the offending behaviour itself.

Readiness for anger management: clinical and theoretical issues.

Anger management methods are a common and successful feature of contemporary cognitive behavioral therapy. Meta-analyses and narrative reviews of the outcome of anger management have been broadly supportive of the view that it is an effective approach. We argue in this paper that an important impediment to the future success of anger management is the failure to fully address the issue of treatment readiness. We discuss distinctive features of anger that make readiness a more important issue than it is for other problem emotions and affects. Relevant theoretical models of readiness are discussed and we review the components of a lack of readiness, including difficulties in establishing a therapeutic alliance. Progress in this area requires greater attention to the measurement and analysis of readiness, to its inclusion as an independent variable in outcome studies and to its clinical modification when readiness is low.