Ms Melanie Mitchell1, Dr Jennifer Wells1
1Qld Forensic Mental Health, Paddington, Australia
Literature discussing therapeutic interventions with mentally ill clients has a propensity to describe generalist therapeutic frameworks, neglecting to outline the specific strategies and techniques used. The aim of this paper is to describe in detail the therapeutic strategies employed in relation to five mentally ill stalkers who were community clients of a specialist forensic mental health service. Therapy session notes were analysed using qualitative methods to identify client factors, therapy frameworks, therapy strategies and impediments to therapy. In all cases, the therapy progressed in a non-linear model using a mixture of CBT, DBT, narrative therapy, positive psychology and solution focussed psychology in order to meet the specific needs of the client. Therapy topics included: engaging the client, psycho-education about stalking, coping skill development and relapse prevention planning. The themes associated with success, such as rapport building and adapted communication, and themes associated with lack of progress, such as cognitive rigidity and anger towards the mental health system, were identified. In all cases, progress was slow-going with more than one barrier arising during the course of the therapy, including psychotic relapse and treatment changes. This paper provides an overview of techniques that worked well during therapy with psychotic stalkers and highlights how clients with similar diagnoses and forensic behaviours (stalking) can require different therapeutic frameworks and a manualised approach with such clients may not be effective. It is hoped that the candid reporting of the therapeutic process of these cases will assist and guide other therapists working with mentally ill stalkers.
Melanie is a psychologist with over 15 years forensic experience in Australia and the UK. She currently works at the Qld Forensic Mental Health Service, is a researcher with Qld University of Technology and runs a Threat Assessment and Management company in Queensland.