ABSTRACT
Working psychoanalytically in the settings necessarily affects how we work, and adaptations have to be made. It is a frequent misperception that people in high-secure hospital conditions are referred to as prisoners. This is the familiar pull towards a custodial and punitive focus and away from the idea of treatment, often misconstrued by the general public as condoning the awful offences that have been committed. What is required is the right balance for each individual case between the provision of treatment by the mental health professionals on the one hand, and loss of freedom within a secure environment as required by the criminal justice system on the other. The difficulties in achieving this balance contribute to one of the particular dynamics when working under conditions of high security, where providing treatment and security can clash.
