Schema Focused Therapy for Forensic Patients with Personality Disorders: New Research Findings

Abstract

Rationale:

Schema Focused Therapy (SFT) has proven effective in outpatients with Borderline Personality Disorder (PD)(Giesen-Bloo et al., 2006). To test the effectiveness of SFT with forensic patients, we have begun a multi-center randomized clinical trial of SFT for male forensic patients with Antisocial, Borderline, Narcissistic, or Paranoid PDs.

Methods:

One hundred twenty patients will be enrolled from 7 high security forensic hospitals (“TBS clinics”) in The Netherlands. Patients are randomly assigned to receive either SFT or usual forensic treatment. Patients receive 3 years of therapy, and are assessed every 6 months for changes in PD symptoms, recidivism risk, and other outcomes. Following treatment completion, patients will be followed an additional 3 years to assess actual recidivism.

Results:

Since 2007, 39 patients (mean PCL-R score = 25.0, SD = 6.6) have been enrolled in the study, 22 have completed their 12-month assessments, and 11 their 18-month assessments. Only 3 have dropped out. Recruitment is ongoing, with expected completion of the project in 2012. Pilot data on a different sample of N = 18 forensic PD inpatients treated in SFT for a mean of 1.9 years (SD = 0.8) is encouraging. Nine of the 18 patients showed reliable improvement, and only one showed reliable deterioration (mean d-score = 0.84, SD = 0.95, p < .01).

Conclusions:

SFT appears to be a promising treatment for forensic patients with Antisocial and other Cluster B PDs.