Working with hard-to-reach patients in difficult places - a Democratic Therapeutic Community approach to clinical consultation

The difficult relationship between the forensic patient and the system of care is characterised by the giving and taking of offence. The capacity of the individual to act out violently an offended state of mind is what has resulted in his entry into the forensic system, rather than any more conscious motivation for treatment or recovery. In relation to the offender, the wider social systems in turn, for the most part, cannot help but be offended. Those who offend and those who are offended then enter into a reciprocal relationship in which violence and offence of different sorts are transacted in both directions (Scanlon and Adlam, 2009a). In this chapter we attempt to examine 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.