The HoST programme: A pilot evaluation of modified dialectical behaviour therapy with female offenders diagnosed with borderline personality disorder

The Holloway skills therapy programme (HoST) at Her Majesty’s Prison and Young Offenders’ Institution Holloway is provided to women who, because of problematic behaviour associated with borderline personality disorder, are often excluded from treatment in prison and in the community. HoST addresses issues of offending behaviour, self-harm, suicidality and indiscipline, through a modified evidence-based treatment modality, dialectical behaviour therapy (DBT), which is a form of cognitive behaviour psychotherapy. This paper will outline the possibility of a modified DBT approach to working with female offenders in the prison setting. A pilot evaluation of female prisoners who received the treatment is also presented through a range of quantitative measures. In turn, positive outcomes with regard to reduction in time spent on the assessment and care in custody teamwork process, reduction in adjudications and improved overall mental health are presented. These findings are discussed along with the implications for clinical practice in the prison setting. The need for future structured research is also discussed.     

Religion and obsessive-compulsive disorder (OCD) among young Muslim women in Saudi Arabia

Fifteen young women suffering from OCD in Saudi Arabia were interviewed about their experience of the illness and the roles played by religion. Religion was not perceived as a cause of the illness, but the illness can show itself in religious symptoms – notably with respect to prayer, and in a phase in which the young women were very strict and literal-minded with themselves and their families, with respect to religious observance. Religious symptoms were reported as more upsetting than other symptoms – being seen as damaging to the sufferer's piety. Other facets of the importance of religion in the experience of OCD were shown in help-seeking, in choosing to go first to religious healers for treatment, and only when these were unsuccessful were mental health professionals consulted. At this point, it was very important that the professional should be seen as trustworthy, and the criterion of trustworthiness was religiosity, specifically the use of pious, Qura’anic quotations, and a covered face (for a woman)/long beard (for a man). The accounts of the roles of religion in the experiences of the young women interviewed suggest that religion is an arena – but not the sole arena – for the expression of OCD symptoms. Religion plays an important role in determining the acceptability of treatments and treatment providers.     

Revelation,delusion or disillusion: subjective interpretation of religious and spiritual experiences in bipolar disorder

The objective of this study is to explore the interpretation of religious and spiritual experiences during mania, depression and recovery, from the perspective of bipolar clients and to inquire into their expectations of treatment in relation to these experiences. For this purpose, a qualitative pilot study is designed, which includes interviews with 10 outpatients of Altrecht, a Dutch mental health institution. The meaning of religious and spiritual experiences and the question of their authenticity proved to be an important theme for the participants. The support of spirituality for illness management was brought to the fore, as well as the temporary lack of this support during depression by some participants. Participants considered it desirable that more attention be paid to the topic during treatment, and to establish better cooperation between spiritual counsellors of the institution and other professionals. Thus, a more existential or hermeneutical approach towards religious experiences in relation to bipolar disorder would be a desirable contribution to standard treatment. The exact outlines of such an approach demand more empirical research.     

Treatment of Posttraumatic Stress Disorder Following an Armed Robbery: A Case Study Testing the Transportability of Trauma-Focused Cognitive-Behavioural Therapy to Urban Africans

John, an urban African male who developed posttraumatic stress disorder (PTSD) following an armed robbery at the petrol station where he worked, was treated with 12 sessions of Trauma-focused cognitive behaviour therapy. Intervention involved a combination of psychoeducation, prolonged imaginal exposure, cognitive restructuring and behavioural assignments. This article is a systematic case study of his treatment which included a comprehensive narrative and tracking of progress by means of the Posttraumatic Diagnostic Scale. John responded well to the treatment, finding it acceptable and credible and remained free of PTSD symptoms at 15 months follow up. It is argued, based on the principles of Elliott's Hermeneutic Single Case Efficacy Design, that there is evidence from within the narrative that it was the treatment that led to remission of symptoms. This case study demonstrates the cognitive, emotional and behavioural processes underlying John's PTSD, which fits with those extensively described in the research literature, and that this evidence-based treatment developed in a westernised context is transportable to work with urban Africans.     

Behavioural characteristics of offenders with mental health disorders in a South African prison population

This exploratory study profiled behavioural characteristics of a non-random sample of 91 offenders with mental illness in a South African correctional facility. The sample is directly related to diagnosed cases from the correctional psychiatrist's case load. The most prevalent mental disorders diagnosed amongst the research participants of this sample specific profile were schizophrenia (33%), major depressive (27.5%), bipolar mood (12.1%) and psychotic disorders (11%).     

Post Abortion Syndrome is a Clinical Reality: A Critical and Methodological Reflection on the Politics,Biology and Phenomenology of Unwanted Pregnancy and Abortion

Macleod (2009) criticizes Boulind and Edwards (2008) for using the concept of post-abortion syndrome (PAS) in their conceptualization of the case of Grace. This article responds to this by arguing the following points: 1) the appropriation of PAS into anti-abortion rhetoric is not sufficient reason to abandon it since this rhetoric distorts the facts, 2) methodological difficulties cited by Macleod in identifying the nature of the distress experienced by some women post-abortion are an artifact of the use of multivariate statistical methods which are not appropriate for answering these questions; 3) the well documented process of maternal foetal attachment, which has a neurobiological basis, shapes a pregnant women's experience of the foetus in the direction of experiencing it in personal terms; 4) the incorporation of this into the clinical concept of PAS carries no implications about foetal personhood; 5) there is considerable documentation of the loss of a foetus being experienced as a bereavement by some women and giving rise to a traumatic grief response; 6) there is a difference between a formal diagnosis in a diagnostic manual and a clinical syndrome which can guide case formulation. It is concluded that the presentation of the case of Grace, rather than offering evidence that supports a pro-life stance on abortion, is an example of the kind of emancipatory theory and practice that is advocated by Macleod.     

“Whenever Jack sees a condom,he falls asleep”: experiences of condom use and erectile disorder among HIV positive men in a Zimbabwean rural setting

In this qualitative inquiry, we set out to explore the experience of condom use and erectile disorder (ED) among men living with HIV in a rural district of Zimbabwe. Data on condom use related erectile disorder with antiretroviral (ART) medication were collected from a purposive sample of 18 men living with HIV and AIDS (age range 23–54 years). These data were supplemented with those from a convenience sample of 23 women living with HIV who self-identified as partners of men living with HIV and AIDS (age range 26–37 years). The data were thematically analyzed. Results suggest that men attributed their experiencing of erectile problems to two main explanations: use of condoms and ART medication. These men reported inconsistent use of condoms and/or adherance to ART therapy due to a belief that these cause their ED. The women informants reported similar observations, including the shared gendered perspective that the men perceived a loss of sense of manhood from ED. Beliefs that influence health promotion with men living with HIV and AIDS are important to public health interventions with them.     

Educators' Perceptions of Attention Deficit Hyperactivity Disorder: An Exploratory Study

The study investigated the perceptions of educators about Attention Deficit Hyperactivity Disorder, specifically their views on its incidence, causes and appropriate interventions in school settings. Five purposively selected educators from a private school participated in the study. Ethnographic interview was used to collect and analyze the data. The results revealed that the educators considered ADHD mainly a physiological disorder with primarily genetic and environmental causes. Regardless the educators preferred medication as the intervention method despite being aware of additional intervention methods.     

The Relation between Mind‐mindedness in Mothers with Borderline Personality Disorder and Mental State Understanding in their Children

This study investigated relations between mind‐mindedness in mothers with borderline personality disorder (BPD) and mental state understanding in their children. Participants were 20 mothers with BPD and 19 mothers without personality disorder and their children, aged 39–61 months. Children's mental state understanding was examined via a battery of theory of mind and emotion labelling tasks. Maternal mind‐mindedness was assessed by mothers' use of mental state references to describe their children relative to other attributes. Maternal BPD was associated with fewer references to children's mental states as well as poorer levels of mental state understanding in their children. Findings lend some empirical support to recent theoretical suggestions that BPD is associated with a reduced capacity for mentalization, as well as reduced capacity for mental state understanding in children of mothers with BPD. Copyright © 2012 John Wiley & Sons, Ltd.     

Sexuality,Intimacy, and Recovery

Human sexuality is an inseparable part of the yearning for intimacy, merging, and touch, both for people in general and for those with severe mental disorders. The exploration and acceptance of sexuality and the yearning for intimacy are vital to the recovery process of people with severe mental disorders. Despite this importance, therapists appear to disregard sexual issues in therapy with people with severe mental disorders. This article discusses the sexuality difficulties of these patients resulting from their personal history and examines the difficulties of therapists and therapeutic institutions in dealing with these patients’ sexuality-related issues.