This pilot study compared the efficacy of two models of family therapy plus medication in the treatment of ten schizophrenic patients previously considered poor responders to neuroleptics alone. Focal Family Therapy (FFT), a limited psychodynamic model, was compared with Supportive Management Counselling (SMC), an educative, problem-solving approach. Family treatment was begun during admission to hospital and continued for up to six months post-discharge. Patient and family measures were administered on assessment, termination, and at three, six and 12 month follow-up interviews. Our data suggest that patients in both groups improved significantly following treatment on measures of social functioning and community tenure. The average increase in amount of time out of hospital was a full year, compared to previous rates. Patients receiving FFT demonstrated significantly greater improvement in symptoms, compared to patients in the SMC group. On average, families scored in the normal range on the family functioning measure at assessment and upon termination of treatment.

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The debate on what can be effectively done to reduce crime, protect members of the public and lower recidivist rates continues in many quarters. As a result there are now several behaviour programmes delivered by the Home Office. In this article I intend to discuss psychodrama as a treatment approach that has been used for the past 20 years at H.M.P. Grendon Underwood and how its application can change the disruptive internal worlds of those who offend.

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