First, I commend the authors on choosing a title that even Hollywood would be proud of! It has, without fail, enticed all visitors to my house to pick up the book and read the back cover. But does the book do justice to its dramatic name?
Admittedly, it is not a gripping thriller but it held my interest (commendable in itself). Its theoretical background is psychodynamic psychotherapy; the contributing authors are primarily psychotherapists who have significant experience within forensic settings. The book raises the profile of countertransference in forensic settings, especially how its influence can permeate through the layers of an organisation and significantly affect patients, staff, systems and care. It is written to bring meaning and support to staff as they attempt to ‘emotionally care for the “intolerable’”.
One of the strengths of the book is that each chapter can be read in isolation and they offer a comprehensive march through the various ‘microsystems’ that form the forensic National Health Service institution: nursing staff, individual and group psychotherapy, supervision, management dynamics, interpersonal dynamics in in-patient care, organisational consultancy. The chapter on the supervision of managers is particularly welcome as illustration that no member of an institution is immune to the effects of countertransference and that all could benefit from the space to reflect and ‘feel’ about their work. Excellent clinical examples are included that bring the material to life. In criticism, consideration of community forensic settings is missing and, as is often the case, discussion of care for those in prison. However, the authors have remained within their field of expertise and the specification of the book.
The case for reflective practice is well marketed here, but my cynical side would prefer a frank evaluation of staff groups by a ‘participant’, which avoids the risk of portraying reflective practice in an idealised manner. At the end of the day, it's meaningless if the staff don't benefit.
As someone who is already on the forensic psychotherapy bandwagon, I welcome this publication as I think it (very successfully) makes a case for the existence of forensic psychotherapy. This is an eminently readable and thought-provoking book for staff and managers in forensic settings, with excellent writing capturing how challenging this work can be. I will end this review with my particular favourite phrase, from the book's foreword: ‘The most useful vaccination against the impact of madness is to create meanings in its place’.
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