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Background Violent criminal offenders with personality disorders (PD's) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs. Methods We compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise-specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms. Results Patients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes – rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms – and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*time: t(1387) = −2.85, p = 0.005). Conclusions These findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community.

Purpose Forensic vigilance is a central competency that forensic professionals need to meet the complex demands of working in forensic settings. Until recently, no instrument for forensic vigilance was available. This study aims to develop a self-assessment tool of forensic vigilance for individuals and teams working in forensic settings, and investigated its psychometric properties. Design/methodology/approach The Forensic Vigilance Estimate (FVE) was presented to 367 forensic psychiatric professionals and 94 non-forensic psychiatric professionals by means of an online survey. Professionals rated themselves on 15 aspects of forensic vigilance. Findings The results indicated that the FVE had good psychometric properties, reflected by a good to excellent internal consistency (Cronbach’s α of 0.903), a good split-half reliability (0.884) and good test–retest reliability (0.809). The factor structure of the FVE was captured by a one-factor model (RMSEA 0.09, SRMR 0.05, TLI 0.91 and CFI 0.92). Proportion of explained variance was 52%. Forensic professionals scored significantly higher than non-forensic professionals on the FVE (t(459) = 3.848, p = 0.002). Practical implications These results suggest that the FVE may reliably be used for research purposes, e.g. to study the effects of targeted training or intervention or increasing work experience on forensic vigilance or to study which factors influence forensic vigilance. Originality/value This study represents the first attempt to capture forensic vigilance with a measuring instrument.

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Purpose Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders. Design/methodology/approach The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates. Findings Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant. Practical implications These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders. Originality/value The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders.