Volume 7 Supplement 1

World Psychiatric Association (WPA) Thematic Conference. Coercive Treatment in Psychiatry: A Comprehensive Review

Open Access

Relationship influences for probationers with mental disorder

  • Jennifer Skeem1
BMC Psychiatry20077(Suppl 1):S54

DOI: 10.1186/1471-244X-7-S1-S54

Published: 19 December 2007

Background

Many probationers have serious mental disorders that complicate supervision. Compared to their relatively healthy counterparts, probationers with mental disorder (PMDs) are at double the risk of probation failure and incarceration. In an effort to improve outcomes for PMDs, some U.S. jurisdictions have developed specialty mental health caseloads. In these specialty programs, officers with interests or training in mental health supervise reduced caseloads comprised of PMDs. These caseloads reintroduce the notion of treatment to supervision and embody tension between the goals of protecting community safety ("control") and promoting offender rehabilitation ("care"). Specialty mental health officers are tasked with negotiating these dual roles. In this presentation, I describe the key dimensions of these dual role relationships and their impact on PMDs'outcomes. Although research indicates that the therapeutic alliance affects outcomes more strongly than the specific techniques applied, measures of the alliance do not capture the dual roles inherent in relationships with involuntary clients.

Methods

In this multi-trait, multi-method study, we developed and validated the revised Dual-Role Relationships Inventory (DRI-R).

Results

Based on a sample of 9 specialty officers and 90 PMDs who were assessed and then followed for a year, we found that (a) relationship quality in mandated treatment involves not only caring, but also fairness, trust, and an authoritative (not authoritarian) style, (b) the DRI-R assesses these domains of relational fairness, is internally consistent, and relates coherently to with ratings of within-session behavior and measures of the therapeutic alliance, relationship satisfaction, symptoms, and treatment motivation, and (c) the quality of dual role relationships predicts future compliance with the rules, as assessed by probation violations and revocation.

Conclusion

Beyond technical interventions, the process of care and supervision is crucial.

Authors’ Affiliations

(1)
University of California, Irvine

Copyright

© Skeem; licensee BioMed Central Ltd. 2007

This article is published under license to BioMed Central Ltd.

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