This groundbreaking book explores the psychodynamics and socio-politics of the forensic therapeutic milieu, addressing some of the most difficult and complex issues facing practitioners. It sets out a psycho-social framework for understanding the predicament and the needs of those who live in and those who work in forensic mental health settings. It brings to life the thinking of those working on the frontline in an increasingly difficult and hostile environment, and draws together fresh and stimulating approaches to engagement with highly complex individuals who present challenges to traditional models of psychiatric assessment and treatment. Contributors with considerable clinical experience and expertise from a range of disciplines consider the ethical, emotional and intellectual challenges of their work, and describe ways in which genuine containment and change can be achieved despite numerous perceived assaults on therapeutic relationships, and on the therapeutic milieu itself. Combining clinical case studies with organisational perspectives and clear descriptions of theoretical processes, they explore key issues including the challenges of maintaining role-appropriate, 'boundaried' relationships; the tensions between public protection and individual confidentiality; questions of risk and responsibility; duty of care and respect for individual liberty; the challenges posed by inter-professional tensions and rivalries; as well as specific clinical dilemmas. The difficulties they experience in fulfilling specific therapeutic roles in the face of uncertainties about the funding and commissioning of their services are addressed, and the final part of the book outlines some of the ways in which individuals, particular services and whole organisations may protect themselves when under attack. This unique and highly original book is essential reading for all those working, or training to work, in both forensic and non-forensic inpatient therapeutic milieux and for academics and lay readers interested in the societal dynamics of inclusion and exclusion that are replicated and magnified in these settings.

This book explores how ‘the hostile environment’ of neoliberalism affects art therapy in Britain. It shows how ambiguity in art and in psychoanalytically understood relationships can enable art psychotherapy groups to engage with class dynamics and aspire to democracy. The book argues that art therapy needs to become a political practice if it is to resist collusion with a system that marginalises collectivity and holds individuals responsible for both their suffering and their recovery. It provides accounts of the contradictions that are thrown up by neoliberalism in art therapists’ workplaces as well as accounts of art therapy groups with those affected by the fire at Grenfell Tower, in an acute ward, a women’s prison, a community art studio and in a refugee camp. Written by art psychotherapists for arts therapists and other mental health workers, the book will bring political awareness and consideration of resistance into all art therapy relationships, whatever the context and client group.

Forensic psychotherapy explores the roots of violent, sexual and antisocial behaviour. It is a relatively recently created discipline that applies psychoanalytic knowledge to the assessment, management and treatment of mentally disordered offenders, forming a bridge between traditional forensic psychiatry – with its focus on diagnosis and risk – and traditional psychotherapy – with its focus on understanding why things happen. As a discipline, forensic psychotherapy seeks to understand the conscious and unconscious motivations that underpin specific offending behaviours. We need to understand not only the detail of the crime, but also the offender as a whole person within his environment, including the criminal justice environment. It aims to understand the perpetrator, the victim, and the victim within the perpetrator. In this collection, leading international experts in forensic psychotherapy explore the different aspects and developments within the field. These include first hand experiences of shaping the emerging discipline within the UK, Europe and the United States; working therapeutically with high-risk offenders in prisons and secure hospitals; exploration of female violence and work with incarcerated mothers and babies; and the latest developments in forensic psychotherapy training. This book will be of interest to professionals and academics working within the fields of forensic mental health, criminal justice, psychiatry, psychology, criminology, and sociology. This book was originally published as two special issues of Psychoanalytic Psychotherapy.

The writings and activities of Bruno Bettelheim have forever changed perceptions of the treatment of children in residential care. His concern with milieu, or the meaning of the environment for mental health, has contributed not only to the psychoanalytic treatment of troubled children and adolescents, but also to a theory of person and environment, fostering morale and enhanced personal integration. His emphasis on the importance of the hour by hour management of children's daily living experiences and his attribution of a critical therapeutic role to the caretaker have profoundly influenced treatment as well as the recruitment and training of child care counselors and caretakers. Milieu Therapy: Significant Issues and Innovative Applications, a tribute to Bettelheim, illuminates continuing efforts to further understanding of the caring process and its impact upon healing and repair measures for disturbed children. The contributing authors of Milieu Therapy have themselves been influenced by the work of Bettelheim. In this book they: distill and clarify Bettelheim's clinical legacy survey a select group of his political and clinical articles describe how communication can be fostered between residents and staff through the architectural design of the residence, holiday celebrations, and students'choices of reading material address management issues posed by youngsters with symptoms of character disorder and provide a description and examples of a three level style of response to these children discuss the impact of the milieu of college residence on the lives of students and the problems and opportunities of group life According to D. Patrick Zimmerman, one of the contributors, " . . . [Bettelheim] was instrumental in promoting a lasting concern about discovering the best treatment methods possible for emotionally disturbed children. . . . He taught many of us . . . to deeply care and think about the fate of even the most severely impaired children. His arguments . . . continue to stimulate us to unashamedly examine ourselves in our work with troubled youth." Professionals who work with children and are interested in the impact and influence of Bruno Bettelheim and his work will find a wealth of knowledge in Milieu Therapy: Significant Issues and Innovative Applications.

Therapeutic architecture can be described as the people-centered, evidence-based discipline of the built environment, which aims to identify and support ways of incorporating those spatial elements that interact with people physiologically and psychologically into design. Architecture is an important factor in people's lives when they are well; when they experience ill-health and are less able to cope it becomes even more important. This book explores the design of specialized residential architecture for people with mental health problems. It sets out to show how building design can support medical and health related procedures and practices, leading to better therapeutic outcomes and an enhanced quality of life. Based on almost two decades of research, it aims to understand how architectural design interacts with the therapeutic milieu, the care programs, and actually living in the spaces. The book is divided into two main parts covering theory and research. Part one consists of three chapters: a brief introduction to old practices, current medical psychosocial and architectural thinking, and alternative thinking. Part two explores the research and conclusions derived from fieldwork. This book provides a fascinating insight into the effect that architectural design can have on all of us, but particularly on those with mental health problems. "Dr. Evangelia Chrysikou explains the many aspects of mental health and its relation to the quality of the built environment and I strongly recommend this very enjoyable book to anyone who would like to find out more about this important topic." - Prof. Alan Dilani, Ph.D. , International Academy for Design and Health "This book provides important, evidence-based data that will help to drive the design of new and refurbished psychiatric facilities and will no doubt become a highly-regarded resource for medical planners and architects." - Jo Makosinski , Editor, Building Better Healthcare

In perceiving all rap and hip-hop music as violent, misogynistic, and sexually charged, are we denying the way in which it is attentive to the lived experiences, both positive and negative, of many therapy clients? This question is explored in great depth in this anthology, the first to examine the use of this musical genre in the therapeutic context. The contributors are all experienced therapists who examine the multiple ways that rap and hip-hop can be used in therapy by listening and discussing, performing, creating, or improvising. The text is divided into three sections that explore the historical and theoretical perspectives of rap and hip-hop in therapy, describe the first-hand experiences of using the music with at-risk youth, and discuss the ways in which contributors have used rap and hip-hop with clients with specific diagnoses, respectively. Within these sections, the contributors provide rationale for the use of rap and hip-hop in therapy and encourage therapists to validate the experiences for those for whom rap music is a significant mode of expression. Editors Susan Hadley and George Yancy go beyond promoting culturally competent therapy to creating a paradigm shift in the field, one that speaks to the problematic ways in which rap and hip-hop have been dismissed as expressive of meaningless violence and of little social value. More than providing tools to incorporate rap into therapy, this text enhances the therapist's cultural and professional repertoire.

Since 1948, people suffering from mental health issues, mental health professionals, and committed volunteers have gathered at Fountain House in New York City to find relief from stigmatization and social alienation. Its “working community” approach has earned the organization vast critical recognition, enabling it to replicate its methods across the world. This volume describes the humanity, social inclusivity, personal empowerment, and perpetual innovation of the Fountain House approach. Evidence-based, cost-effective, and transferable, this model achieves crosscultural results by supporting the principles of personal choice, professional and patient collaboration, and the need to be needed, achieving substantive outcomes in employment, schooling, housing, and general wellness.

The central theme of this book is the operation of intersecting discourses of power, privilege and positioning as they are revealed in fraught encounters between in-groups and out-groups in our deeply fractured world. The authors offer a unique perspective on inter-group dynamics and structural violence at local, societal, cultural and global levels, dissecting processes of toxic ‘othering’ and psychosocial (re-)traumatisation. The book offers the Diogenes Paradigm as a unique conceptual tool with which to analyse the ways in which those of us who come to be located outside or on the margins of dominant social structures are, in one way or another, the inheritors of the legacies of centuries of oppression and exclusion. This analysis offers a distinctive psycho-social redefinition of trauma that foregrounds the relationship between the inhospitable environments we generate and the experiences of un-housedness that we thereby perpetuate. Written in an engaging and accessible style, Psycho-social Explorations of Trauma, Exclusion and Violence directly addresses pressing global issues of racial trauma, human mobility and climate disaster, and offers a manifesto for the creative re-imagining of the places and spaces in which conversations about restructuring and reparation can become sustainable. This is an essential and compelling book for anyone committed to social justice, especially for all practitioners working in health, social care and community justice settings, and researchers and academics across the behavioural and social sciences.

People who use forensic mental health services are defined by the fact that they have violated boundaries, often in many ways. For clinicians employed to work therapeutically with this client group however, the capacity to initiate and maintain boundaries is critical to safety as well as to good treatment outcomes. This book provides a thorough introduction to the subject of professional and therapeutic boundaries and their particular complexities within forensic mental health settings. The contributors, all experts in their respective fields, address the challenges of establishing working boundaries within forensic mental health services from multiple perspectives. They explore the ways in which boundaries can be initiated and maintained in different areas of forensic mental health work, including in psychotherapy, mental health nursing, arts therapies, forensic psychiatry and family therapy, and when working with different client groups, including children and adolescents, offenders with severe personality disorders in high security settings and sex offenders. Consideration is also given to boundaries and homicide, maternal boundary violations and boundaries in a forensic learning disability service. This authoritative, interdisciplinary resource will support all forensic mental health practitioners in this crucial aspect of their work.