Working with hard-to-reach patients in difficult places: a democratic therapeutic community approach to consultation
The difficult relationship between the forensic patient and the system of care is characterized by the giving and taking of offence. Those who offend and those who are offended enter into a reciprocal relationship in which violence and offence of different sorts are transacted in both directions. This chapter examines the quality of hostile dependency that lies at the heart of this relationship, most obviously in the case of recidivist offenders and chronically disturbed and excluded personality disordered individuals. It describes some of the obstacles to engagement between offenders and the offended. The chapter illustrates some of the practical difficulties in this relationship using composite clinical material. It concludes with an exploration of a model of outreach and inreach a model that is derived from the experience in democratic therapeutic communities, and of the ways in which this model can be helpfully applied to other services working with the excluded forensic client.