‘Even after the worst possible days, what’s sustaining is the connections’

After nine or so years working in the prison service, I felt ready to move outside. The service and forensic psychologists were doing some brilliant work, but prisons are first and foremost places that are organised and managed to detain people safely. What I really wanted was somewhere where the therapeutic overlay was of equal importance.

I had started working as a forensic psychologist at HMP Maidstone, before moving to HMP Parkhurst and working on a Control Review Committee special unit. This took some of the most disruptive prisoners in the prison system and worked very intensively with them. After that I went to work at Broadmoor Hospital and retrained as a clinical psychologist. I'd become increasingly interested in the clinical aspects of my work and felt like I would really benefit from a broader-based training. I knew that I wanted to remain in the field of forensic psychology, but I wanted to have an opportunity to look at offenders across the lifespan, with different models and frameworks to draw upon in formulating understandings of the individual. Different challenges affect us all as we go through our lives, and I wanted to apply an understanding of that to forensic work.

Say you were an offender who had also had victim experiences – and there are plenty of people who are in that situation – and you were sitting in a place where it can be really tough just to exist, to survive. Being able to work on some areas might not feel safe, psychologically, to undertake. I became a Consultant Clinical and Forensic Psychologist at Broadmoor, and felt I was somewhere where there was that shift in how people could engage in what we were offering.

I then briefly went to Rampton Hospital, where they were developing a joint initiative between the NHS and Ministry of Justice, to open a Dangerous and Severe Personality Disorder unit. After that I moved to work in a Medium Secure unit in East Sussex.

Psychologically-informed environments

I had a career break to have my son and then worked for myself for a while. I went into independent practice, but I've also worked as a consultant in drug and alcohol services in the community and as a consultant in a homelessness service, working with people from forensic backgrounds and supporting staff teams.

I set up a psychologically-informed environment in one of their houses, which was just joyful really. It housed a group of people with multiple needs, including forensic histories, substance abuse and mental health issues. They had a history of being routinely evicted because they struggled to maintain a tenancy. The service has six people, predominantly men, and everyone has a say in the way in which the residence runs. We won money to build a garden, changed the look of the building, and shifted from being somewhere that would talk about eviction and tenancy rules to somewhere that would talk about respectful living, relationships and community.

We had this amazing guy who lived there for a while: long forensic history, street homelessness, substance misuse, self-harm and mental health issues, and a background of trauma. He was really reluctant to come into the project, and once he was in, we were very respectful of his space. He refused to let us into his premises… we would knock and ask to see how he was doing and have a conversation, and he was adamant he wasn't going to let us in. Gradually, over time, we would keep knocking and he'd let us into the hallway, then eventually into his room. I can remember the first time I went into his room in the studio flat where he lived, after four or five months. We'd given him a bed pack when he first moved in and when I walked into his room it was still in its package, several months on, rolled up on his bed. He'd been sleeping on the floor rather than using his bed. I asked him why, and he said to me, 'I can't afford to let myself believe that I might one day be able to sleep in a bed'. It was a really powerful moment. He said, 'if you come in here and see the mess I've made in here, and I'm still using, you're going to take my flat off me, aren't you?'. And the fact was – we didn't. We gave him lots of support, and I think it was another three or four months before he had the trust in us and the courage to sleep in his bed.

Together

Half of my current job is working as Interim Director, along with psychologist Dee Anand, for Criminal Justice Services at the charity Together for Mental Wellbeing. I've got a ten-year history of working with Together, which is one of the oldest mental health charities in the country, and I've been providing supervision for the Criminal Justice team here for that long. Dee and I share the task of looking after one of the largest liaison and diversion providers for Greater London.

Liaison and diversion involves working with people in police custody and the courts, with a multidisciplinary team, including court officials, judges, lawyers and police. They would be alerting us to any concerns about anybody that they were dealing with who may have mental health problems, or other vulnerabilities like learning difficulties or substance abuse. Our staff complete assessments of the individual and provide a report outlining their findings on that person's mental health and wellbeing – an 'all vulnerabilities' assessment. This informs both the police and courts about what they might do in terms of proceeding with the case through a criminal court, or looking to divert the person into a mental health service or towards other support for their wellbeing. The Community Link Worker service picks people up post-diversion with any vulnerability, including housing or benefit needs, and attends appointments with them to help support, and if necessary, act as an advocate.

I started at the University of Portsmouth as a Senior Clinical Teaching Fellow early in 2018. I've worked at the university for a long time lecturing for them, on their Forensic Psychology MSc programme. They've just started the first year of the professional doctorate and I thought I'd quite like to do some academic work again. I'm really interested in researching the impact of shame and how that affects a person's ability to engage in the therapeutic encounter. I'm also interested in therapists' and forensic psychologists' understanding of shame in the therapeutic encounter: how they work with it, and whether they attend to it in a way that helps the individual in the room to engage with the process of therapy in a helpful way.

Change

I've been working in this field for approximately 34 years, so I've seen a lot of changes in forensic psychology. One of those is a shift towards the greater use of accredited programmes within prison settings. I've seen the rise of the development of postgraduate training of a good calibre for forensic psychologists. I have seen the welcoming in of forensic psychologists, more and more, into what would have previously been clinical domains.

When I joined the prison service, forensic psychologists were a vocal bunch and I think their voice carried some weight. I guess my fear is that forensic psychology has potentially lost a space in which its voice can be fully heard. There's a loss of those voices because we exist in a commissioned-service culture which is target-driven, rather than people-driven, and that's an issue. I would like to see people confident that they bring something unique to the table, both clinical and forensic psychologists. I think we really do and we shouldn't be meek about that. At every level we can make a difference, and that requires confidence on our part, but it also requires people to listen to those voices and be open to hearing that. Key knowledge transfer is about sharing ideas and results, but it must be undertaken in a way that allows for knowledge translation, so that those in receipt of our voices will understand the knowledge we are sharing. This will ensure that psychological knowledge ends up getting to where it needs to go and will do some good.

We exist in a time when the provision of services is more complex. Demands on services and our ability to work in a joined up way with partner agencies can be very, very difficult in this current climate. Reduced resources and great pressure on staff means that patients/clients/offenders may find it very hard to gain access to all those aspects of care to assist them in their rehabilitation in a co-ordinated and timely way. We should offer up the evidence base to those who commission services to enable them to understand the implications of this. We need to be aware of the demands around our ability to have our voice heard and to be sat in the right place at the right time. If we're doing clinical work and hope a person continues on their trajectory towards being the best version of themselves, very often we're conscious of the fact that once we've done the bit of work that we're doing there may be nothing else for that person.

Another challenge is wellbeing. Recent research found approximately 50 per cent of clinical psychologists in the NHS identified themselves as having reached a threshold for clinical depression, so how do you maintain your personal wellbeing while working in this arena? There have been periods when I've really got out of kilter… when work has been all-consuming, and there's a personal cost to that. Often you go into thinking, 'I can't do this anymore, and I want to go and work in a tea room or garden centre or something lovely like that'. It's about having really good supervision and a strong peer group around you. For me, personally, I'm fortunate that I'm able to use humour and to see myself in that way. Perfect isn't possible for anybody, and I have to focus on doing the best I can. That's quite a hard thought to hold onto, but that's what I think we should all be striving to do.

It's the small things

I'm also currently working on a book about Artemisia Gentileschi. She was one of the few female Italian painters of the Baroque period. It was very difficult for women to find a place in art in those days. She's come to the attention of the women's movement recently. She was raped and her case went to court, which was almost unheard of then, and she won. An artist friend introduced me to her work and told me to read about her. Artemisia's life story is fascinating, and the court transcripts are amazing. She was basically tortured in court, ropes wrapped around her fingers and pulled tight, thumbscrews used and her hands broken to ensure she was telling the truth. No such methods were used on the man accused of her rape in court. She had to teach herself how to paint again. I find that story quite captivating and still meaningful today, sadly. 

I'm also interested in looking at core competencies. We have core competencies in forensic psychology that are articulated through the Stage two route to becoming qualified. I've got a colleague at the university, Dr Adrian Needs, and we are trying to put something together jointly on competencies in a broader sense. What are the necessary competencies of a forensic psychologist? What do you need to be able to do to do this thing we call forensic psychology?

The thing that's sustained me throughout my career is that I have had some amazing colleagues, and I think we underestimate that. On a day-to-day basis, I would really like to believe that in a small way I can do a little thing that might make a difference. I get a real buzz if I see students growing, when supervision is going well, if I see clients making progress. For me it's not about grand things… it's the really small things. Maybe that's one of the things that helps sustain me, not looking for big grand things. Even after the worst possible days, and we all have them, what's sustaining is the connections you have with your peers and your colleagues. Always invest in that and work with compassion alongside our colleagues. That's what I really believe.