The Therapeutic Milieu Under Fire

This groundbreaking book explores the psychodynamics and socio-politics of the forensic therapeutic milieu, addressing some of the most difficult and complex issues facing practitioners. It sets out a psycho-social framework for understanding the predicament and the needs of those who live in and those who work in forensic mental health settings. It brings to life the thinking of those working on the frontline in an increasingly difficult and hostile environment, and draws together fresh and stimulating approaches to engagement with highly complex individuals who present challenges to traditional models of psychiatric assessment and treatment. Contributors with considerable clinical experience and expertise from a range of disciplines consider the ethical, emotional and intellectual challenges of their work, and describe ways in which genuine containment and change can be achieved despite numerous perceived assaults on therapeutic relationships, and on the therapeutic milieu itself. Combining clinical case studies with organisational perspectives and clear descriptions of theoretical processes, they explore key issues including the challenges of maintaining role-appropriate, 'boundaried' relationships; the tensions between public protection and individual confidentiality; questions of risk and responsibility; duty of care and respect for individual liberty; the challenges posed by inter-professional tensions and rivalries; as well as specific clinical dilemmas. The difficulties they experience in fulfilling specific therapeutic roles in the face of uncertainties about the funding and commissioning of their services are addressed, and the final part of the book outlines some of the ways in which individuals, particular services and whole organisations may protect themselves when under attack. This unique and highly original book is essential reading for all those working, or training to work, in both forensic and non-forensic inpatient therapeutic milieux and for academics and lay readers interested in the societal dynamics of inclusion and exclusion that are replicated and magnified in these settings.

John Adlam is Consultant Adult Psychotherapist in Reflective Practice and Team Development for forensic secure services within South London and Maudsley Foundation NHS Trust and Principal Adult Psychotherapist at the South West London and St George's Adult Eating Disorders Service. Anne Aiyegbusi is Deputy Director of Nursing for Specialist and Forensic Services within West London Mental Health NHS Trust. Pam Kleinot is an Adult Psychotherapist at City & Hackney Psychotherapy Department within East London NHS Foundation Trust. Anna Motz is a Consultant Clinical and Forensic Psychologist based within Thames Valley Forensic Mental Health Service and Past President of the International Association for Forensic Psychology (IAFP). Christopher Scanlon is a Consultant Psychotherapist at St Thomas Hospital, London, and Consultant to Forensic Services within South London and Maudsley Mental Health NHS Trust.