Yakeley, Jessica Wood; (2023) Mentalization-based treatment for antisocial personality disorder: Evaluating the implementation of a randomized controlled trial in the UK Criminal Justice System. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

BACKGROUND: In contrast to the health care sector, there is a paucity of randomised controlled studies (RCTs) conducted within criminal justice settings due to cultural, ethical, methodological, and practical challenges, such that many interventions aimed at reducing risk or improving the health of offenders lack a robust evidence base. AIMS: The aims of this thesis are firstly, to identify the barriers to implementing a multi-site RCT of mentalization based treatment for violent offenders with a diagnosis of antisocial personality disorder under the supervision of the UK National Probation Service; and secondly, to explore which theoretical frameworks might offer the best conceptualisation and understanding of the nature, meaning and origins of these barriers to identify preventative or mitigating interventions. METHODS: Semi-structured interviews with a total of 64 staff were conducted via focus groups and individual interviews. All had roles in implementing the trial as therapists, research assistants, coordinating assistant psychologists, probation officers, experts by experience and commissioners. Transcripts were analysed using thematic analysis. FINDINGS: 5 predominant themes were generated for each group. The most cited obstacle to implementing the trial was the emotional impact of researching in criminal justice settings, a finding not previously reported in the literature. Other predominant themes included systemic issues, attrition of participants, and trial methodology and delivery. Experts by experience highlighted challenges in taking up research roles in forming an identity, maintaining boundaries, continuity, and effecting change. Distinct, but complimentary, theoretical models of emotionality from the fields of psychoanalysis, sociology, and criminology were helpful in interpreting these results and in identifying solutions to such challenges. CONCLUSION: Challenges to implementing trials in criminal justice settings should be anticipated at the outset. Strategies to prevent or minimise these should be integral to trial design and methodology, and include interventions, such as reflective practice, aimed at reducing emotional pressures.

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