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Violent women: treatment approaches and psychodynamic considerations
Article · June 2018
DOI: 10.1108/JCRPP-08-2017-0025
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Violent women: treatment approaches
and psychodynamic considerations
Annette McKeown and Ellen Harvey
Abstract
Purpose – Some psychodynamic approaches conceptualise female violence as a communication of
experiences too difficult to think about. As practitioners, understanding what may be too painful to be thought
about is incredibly important in assessment and treatment of forensic populations. Incorporating
psychodynamic concepts such as splitting, transference, projection and counter-transference into
formulation can be extremely helpful in understanding and formulating women’s risk of violence.
The purpose of this paper is to introduce how psychodynamic concepts can be incorporated into
understanding, assessment, formulation and treatment with this complex client group. This paper will also
outline treatment approaches with this population.
Design/methodology/approach – This paper will review existing psychodynamic literature and apply
this knowledge to working with violent female offenders. Translating theory into reflective practice will
be presented.
Findings – This paper presents the value of incorporating psychodynamic considerations into existing
strategies of understanding and working with violent female offenders. Ways forwards and research
directions are proposed.
Research limitations/implications – This paper is focussed primarily on psychodynamic approaches to
understanding this population
Practical implications – Psychodynamic concepts can add an additional dimension to formulation,
supervision and treatment approaches with this population. Examining the meaning of violence perpetrated
by women as well as enactments can improve practitioner’s depth of understanding. Empirical research
examining the benefits of psychoanalytic supervision would be extremely useful to explore the impact on
formulation, treatment approaches, treatment effectiveness, staff well-being and staff retention.
Originality/value – There is a lack of literature considering the application of psychodynamic constructs to
help formulation of complex female offenders in the Offender Personality Disorder Pathway for women.
Annette McKeown is Principal
Forensic Psychologist at the
Primrose Service, Tees Esk and
Wear Valleys NHS Foundation
Trust, Durham, UK.
Ellen Harvey is based at
Primrose Service, Tees Esk
and Wear Valleys NHS
Foundation Trust, Durham, UK.
Keywords Violence, Psychodynamic, Treatment
Paper type Conceptual paper
Introduction
The concept of violent women has been around since the early stages of Greek mythology with
mythological characters of Hera and Procne presenting particularly poignant representations of
women’s capacity to commit severe violence. In the case of both Hera and Procne, each myth
involved the woman murdering children as revenge for marital infidelity. The theme of a mother’s
violence towards her own, or partner’s children, may be considered as a female’s
communication of painful experiences (e.g. Yakeley and Meloy, 2012). In the latter
mythological examples, hurt, betrayal and infidelity present painful themes, which are likely to
be difficult for each woman to consider and process. For clinical practitioners, understanding and
formulating women’s risk of violence, particularly against children, vulnerable victims and intimate
partners can also present as challenging to think about and consider. Examining women’s
risk of violence is vital, however, to ensure comprehensive risk assessment, formulation, risk
management and development of effective strategies of working with this population.
Violent female offenders represent approximately one third of the female prison population in the
UK (Office for National Statistics, 2014). The violence of women also appears particularly likely to
DOI 10.1108/JCRPP-08-2017-0025
© Emerald Publishing Limited, ISSN 2056-3841
j
Received 10 August 2017
Revised 28 October 2017
Accepted 29 October 2017
Dr McKeown is currently
based at the Kolvin Service,
Northumberland Tyne
and Wear NHS Foundation
Trust, Durham, UK.
JOURNAL OF CRIMINOLOGICAL RESEARCH, POLICY AND PRACTICE
continue in custody. For example, in the last ten years, in comparison to men, female offenders in
custody have consistently presented with higher levels of adjudications, and aggression towards
prison staff (Ministry of Justice, 2014).
Female violent offenders are undoubtedly a complex needs client group. Their background
experiences are often characterised by abuse, mental health problems, personality difficulties,
parenting problems and substance use (Coid et al., 2009). Psychological approaches including
psychodynamic thinking can help to provide frameworks to understand these complex
constructs, including how aspects of the woman’s internal experiences may be enacted in her
offending. Enactments may be understood as acting out unconscious, intense emotions linked to
early often painful experiences (Maroda, 2009). Understanding these early experiences and the
symbolic meaning of the violent act can help inform formulation and treatment pathways with this
population (Yakeley and Meloy, 2012).
Understanding female violence
A number of explanations of female violence emphasise gendered pathways into violence.
Gendered pathway literature emphasises women’s journey into the criminal justice system.
This journey is described as often beginning with early victimisation, followed by developing
mental health problems and/or personality difficulties, substance use and relationship
difficulties in adulthood (Salisbury and Van Voorhis, 2009). Some stances consistent with
gendered pathways suggest female violence occurs predominantly in the context of
victimisation. This has led to use of terminology including the “abused aggressor” when
discussing violent women (Swan and Snow, 2003, p. 75). It is important to note there are clear
findings, however, that women also have the capacity for violence outside of an immediate
victimisation context (e.g. Archer, 2004).
When attempting to understand female violence, examining the woman’s background history
and build up to her offending in detail can be incredibly useful as it helps consider whether
there are affective, cognitive and behavioural patterns across different situations.
Consistent with this, some trauma-informed and psychodynamic explanations of violence
suggest if traumatic memories are triggered this may result in repeated enactments
(Brewin et al., 1996). For example, if a woman’s partner behaves in a way which triggers
memories of an abuser or abuse context, the woman may engage in violence as a means of
acting out overwhelming intense feelings such as rage and shame. In such situations, the
woman may be unaware of the specific triggers of her violence at a conscious level (Yakeley
and Adshead, 2013).
It seems particularly relevant that female violent offenders are likely to have experienced trauma
from a greater number of perpetrators than male offenders (Belknap and Holsinger, 2006). Also,
contextually, women have been found to be more likely to be abused by a perpetrator close to
them, with a greater likelihood of abuse continuing over prolonged periods of time (Browne and
Finkelhor, 1986). Findings have indicated females who have experienced sexual abuse during
childhood are more likely to perpetrate violent offences in their teenage years and adulthood
(Siegel and Williams, 2003). The nature of trauma experienced also appears to be particularly
relevant. For example, there are some findings highlighting associations between specific early
experiences and differing presenting difficulties in later life. For example, one study highlighted:
children who experienced being terrorised through aggression were more likely to develop
symptoms of anxiety in adulthood; children who were ignored were more likely to
develop depressive symptoms and borderline personality disorder features; and children who
experienced degradation were most likely to develop predominantly borderline personality
disorder features (Allen, 2008).
In general terms, the early experiences of violent women appear to impact upon their pathway
of development in a variety of ways (Bloom and Covington, 2008). For women who have
experienced trauma, emotional adjustment and interpersonal difficulties are particularly
prevalent (Fusco et al., 2016). The expression of these difficulties may vary considerably for
each woman. For example, one woman may internalise and overcontrol her emotions, whilst
another woman may present with more generally overt undercontrolled presentation of her
JOURNAL OF CRIMINOLOGICAL RESEARCH, POLICY AND PRACTICE
difficulties (Megargee, 1966). Using formulation approaches to examine each woman’s early
childhood experiences, attachment experiences and the meaning they apply to such
experiences can greatly assist an understanding of each woman’s unique pathways into
aggression. Given the frequent presence of trauma, considering attachment (e.g. Bowlby,
1988), personality functioning (Rossegger et al., 2009) and trauma-informed approaches is vital
with this population (Messina et al., 2014).
Psychodynamic approaches can also help understand women’s pathway into violence.
Psychoanalytic thinking generally focusses on two types of violence: self-preservation and
sadistic or predatory aggression (Glasser, 1992; Meloy, 1988). The opening of this paper
presents the psychoanalytic understanding of self-preservation aspects of female violence as a
“defence against underlying psychological distress” (Motz, 2001, p. 7). This model of
understanding is derived from Menninger’s (1938) self-preservation view of violence as a defence
against breakdown and unthinkable distress. In line with this, Motz’s (2001) stance on women’s
violence emphasises the communicative function of violence and how it can manifest as a
defence against emotional pain and trauma. Gilligan (1999) echoes aspects of this, with views
that violence can, in many cases, be triggered by underlying shame and humiliation.
It may be for some women that violence occurs when the defence mechanisms protecting them
from such painful feelings collapse (Winnicott, 1960).
Psychoanalytic thinking generally describes sadistic or predatory aggression as significantly
different from self-preservation violence. Predatory violence is generally described as
characterised by attempts to preserve the suffering of victim and is particularly linked to
psychopathic personality functioning (Yakeley and Meloy, 2012). In line with this, when
attempting to formulate and understand female violence, it is also important to
consider whether more callous predatory qualities are present. Drawing from a variety of
approaches including psychoanalytic perspectives, attachment and trauma-informed
approaches can be useful when attempting to formulate and understand complex female
offenders. This can also add an additional dimension to formulation, particularly in relatively
complex cases of female violence, such as violence against children, which can often occur in
domestic “hidden” contexts.
Hidden violence
Psychodynamic approaches have emphasised the frequent “denial of female aggression” and
“idealization of motherhood” (Motz, 2008, p. 3). This may create a potential blind spot to
women’s capability of violence in certain contexts. Psychodynamic approaches have highlighted
the importance of being aware of potential risks of violence in the domestic arena and the
sometimes secretive nature of women’s violence (McGauley and Bartlett, 2015). For example,
the notion of female domestic violence perpetrators is often in conflict to social expectations of
women (Hester, 2013). This can perhaps link to a general societal misapprehension about
women’s capability of violence (Kierski and Kierski, 2002). It must be also acknowledged that
psychoanalytic concepts are also likely to be useful in understanding the violence of men in
domestic contexts (Mandelbaum et al., 2016).
Consistent with the conceptualisation of secretive female violence, the Dunedin longitudinal
study examined and followed up a cohort of New Zealand births in the early 1970s. The study
highlighted that “inside intimate relationships and the privacy of the home, females are just as
physically aggressive as males” (Moffitt, 2001, p. 69). Historically, there has been a view that
domestic violence is predominantly perpetrated by males (e.g. Dobash and Dobash, 1979).
More recent findings, however, have suggested females perpetrate similar levels of domestic
violence to men (e.g. Archer, 2000, 2002; Bookwala, 2002; Dutton, 2006; Hester, 2013).
Some research has even indicated women can perpetrate more extreme violence in
comparison to males (Cercone et al., 2005). The relationship context presents a comparatively
more common setting for female violence (Hester, 2013). For example, women have also been
found to be more likely to murder intimate partners and less likely to murder strangers in
comparison to men (McKeown, 2010). In contrast to this, there have also been findings that
women tend to suffer more serious injuries than men in a domestic violence context
JOURNAL OF CRIMINOLOGICAL RESEARCH, POLICY AND PRACTICE
(e.g. Dutton-Greene and Straus, 2005; Walby and Allen, 2004). Overall, however, these
findings tend to highlight that the risk of female violence can be intensified within relationships
and domestic settings.
Societal views about the female motherhood role can also trigger strong emotive
responses regarding women who commit violence towards children. It is noteworthy in
2012-2013, in the UK, of the children murdered, 60 per cent of children under the age of
16 were killed by their parents (Office for National Statistics, 2014). In terms of broader gender
differences in parents who have murdered their children, findings have indicated that mothers
were more likely to kill their children at the infancy stage, whereas fathers tended to have killed
children when they were over seven years old (Greenfeld and Snell, 1999). Children below the
age of one have been found at the highest risk of murder (Yarwood, 2004), and the mother is
most frequently the perpetrator (Cooper and Hodgson, 2014). Women’s violence against their
own children highlights interesting psychological considerations for formulation which can be
informed by psychodynamic thinking. These considerations include the potential of women
projecting negative feelings related to their own childhood experience onto their children.
Further considerations relate to the potential of women perpetrating violence against children
as a means of communicating their distress (Motz, 2001). Understanding and managing these
dynamics creates many therapeutic challenges.
Therapeutic challenges and linking to formulation
A woman uses her body as her most powerful means of communication and her greatest weapon.
In a sense [it is] a gesture of protest and in order to elicit help, to communicate her sense of crisis […].
What is too painful to be thought about may be enacted. (Motz, 2001, p. 1)
Working with female violent offenders can present an array of therapeutic challenges. There can
be many benefits of applying psychodynamic thinking to these challenges to help inform
formulation. Undertaking therapeutic interventions with women who have committed extreme
levels of violence including that perpetrated against children, vulnerable victims and prolonged
violent sadistic behaviour can result in clinicians experiencing strong emotions including dread,
anxiety, disgust as well as curiosity (Gazzillo et al., 2015). There may be unconscious aspects of
the therapist that does not wish to know the murderous and violent capabilities of women and the
disturbing aspects of their internal world.
Working with perpetrators of violence who, in many cases, have also been victims can be
extremely challenging for practitioners to process and successfully work with. Transference
may occur where female offenders may re-enact pathological previous experiences in current
therapy. Transference can be described as the displacement of feelings related to
past relationships, often those of childhood significance, onto an individual within a current
relationship (Moore and Fine, 1990). It is often triggered by genuine characteristic but results in
exaggerations or distortion of these characteristics (Thompson, 2014). For example, the
woman who felt powerless in previous relationships may repeat passive interpersonal
dynamics, or conversely may enact aggressive responses to these feelings. Transference often
occurs in relation to relationships with clinicians and can often interfere with treatment
processes (Dahl et al., 2017). Violence may also be enacted through self-harm (Gardner, 2013).
Reflecting upon the transference can assist practitioners as it can help formulate the woman’s
presenting difficulties as the woman is showing her problems to the therapist. Examining
counter-transference, which is an individual’s personal reaction to the transference of another
( Jones, 2004), can also help practitioners reflect, formulate and guide treatment planning
(Clarke-Moore and Aiyegbusi, 2008). For example, if the therapist feels idealised by the woman
in therapy, it can be useful to reflect upon what this may mean about what is important to the
woman and what dynamics may be being enacted.
Therapists may experience projections and may leave sessions feeling helpless or like
they have failed. There are many useful reflections that can be taken from the psychoanalytic
treatment Arthur Hyatt-Williams (1998) undertook in the 1950s, with violent male prisoners in
HMP Wormwood Scrubs. He discussed the frequency of persecutory anxieties
experienced by prisoners and their attempts to remove these experiences through
JOURNAL OF CRIMINOLOGICAL RESEARCH, POLICY AND PRACTICE
projective identification. Projection is defined as a process of transferring repressed negative
feelings about the self onto others, and may act as a defence mechanism against these painful
feelings (Pellegrini, 2010). The awareness of these potential projections can also be incredibly
useful to practitioners working with violent women. Conversely, practitioners may feel like an
extremely successful session has occurred when perhaps little of substance has been
explored (Reisenberg-Malcolm, 1992). The latter dynamic perhaps echoes
Winnicott’s (1960, p. 145) descriptions of the “false self” which he posits can develop in the
early stages of childhood as a result of inadequate parenting from the infant’s mother.
The false self may serve as a defensive mechanism against the “true self”. The false self may
also serve to maintain connection with a comparatively pathological mother (Stern, 1985) and
perhaps as a means of self-preservation (Glasser, 1992). The awareness of these potential
defences can help guide practitioners when formulating and understanding the woman’s
presenting behaviour.
Splitting processes can also occur where the woman may only show one polarised side to herself
within the therapeutic context. For example, the “good” attributes may predominate where the
woman may, for example, describe herself as an “excellent mother” with “perfect relationships”.
This may be in stark contrast to what is documented or known about her. This echoes the
defensive notion of the “false self”. There may also be idealised descriptions of parental
attachments, or indeed, extremely positive descriptions of the therapist working with her (Gregory
and Remen, 2008). Although these polarised idealisations may protect from painful emotions,
they can also present barriers to exploring more destructive components of the woman’s
functioning. This can result in women distancing themselves from their offending and the clinician
being presented with the challenge of helping the women understand and integrate different
components of her functioning.
In custody, offence-paralleling behaviour may occur, although this may be subtle in
nature (Daffern et al., 2010). Emotions, thoughts and behaviours evident at the time offending
may parallel in therapeutic interactions whereby the clinician may feel victimised by the women
they are working with. Conversely, clinicians may feel strong feelings of sympathy with a
desire to rescue and protect the woman they are working with (Karpman, 1968). This may
parallel aspects of the woman’s offending and splitting may occur. For example, in the case of
the woman who has committed child cruelty against her children, she may have been able to
illicit feelings of sympathy and trust from professionals in the community. Such dynamics may
continue in custody where professionals may have positive views of her and the woman
may obtain trusted roles such as a prison listener[1] or prison representative. Some staff
members may be concerned about such roles and splitting in the views of professionals may
be evident (Harvey and Smedley, 2012). For the woman, who in the community was
offending against vulnerable victims, she may be noted to associate with more vulnerable
prisoners in custody. She may also engage in an intimate relationship or a very close friendship
that parallels aspects of her offending. Ongoing clinical supervision, re-visiting formulation,
considering offence-paralleling behaviour and multi-disciplinary working helps teams to reflect
upon and consider dynamics, enactments and risk management strategies when working
with violent women.
Translating psychodynamic thinking into treatment strategies
Traditional psychoanalytic therapy is generally viewed to be unsuitable for the majority of violent
prisoners due to the intensity of treatment and ego strength required (Yakeley and Meloy, 2012).
As noted, however, psychodynamic concepts can be incredibly useful to incorporate into
formulation and can act as a useful foundation to guide and inform treatment strategies.
Concepts such as “holding” (Winnicott, 1971) and “containment” (Bion, 1962) are linked
to therapist’s attempts to contain the individual’s distressing thoughts and experiences, and
can be useful to incorporate into existing treatment strategies. Also, continual monitoring of
counter-transference, projections and dynamics including splitting throughout the therapeutic
process can be particularly useful. As noted, psychoanalytic supervision for therapists,
practitioners and teams working with complex women can also add an additional dimension to
supervision, formulation and treatment planning (Taubner et al., 2017).
JOURNAL OF CRIMINOLOGICAL RESEARCH, POLICY AND PRACTICE
When planning therapeutic interventions and treatment for violent female offenders, the
importance of creating a safe environment is informed by psychoanalytic concepts including
Winnicott’s (1971) notion of the “holding environment”. The holding environment related to the
process of creating a space where supportive relationships can be created and maintained
(Fletcher et al., 2014). Bion’s (1962) conceptualization of containment is also linked to this
concept. Although both concepts are different, the common theme of both is the notion that
experiencing positive attachments and safety in a therapeutic context increases the capacity for
thinking and management of emotions. These concepts can be translated into a variety of
treatment modalities, whereby the therapist places emphasis upon the importance of the woman
feeling contained. In psychological treatment services, good working relationships and
communication between different multi-disciplinary team members can contribute greatly to
creating a holding environment.
Clear boundaries and consistency in therapy can also contribute to creating both of
these psychoanalytic concepts. Providing women with a plan of therapy and session structure
can also be containing. These concepts may also be translated into the physical environment
where therapeutic treatment is undertaken (Bainbridge, 2017). For example, some women may
feel more contained in a larger room and/or in smaller therapeutic groups. In the early stages of
therapy, spending time building the therapeutic relationship as opposed to immediately
exploring challenging aspects such as trauma can be more containing. Also, at this stage,
helping women to build psychological skills to manage their emotions and any overwhelming
current trauma symptoms can be incredibly important. This is in line with views highlighting the
value of focussing on the “here and now” in early stages of treatment (Linehan, 2014).
For example, dialectical behaviour therapy (Linehan, 1993) is one such therapeutic approach
that can help women to develop mindfulness skills, interpersonal skills, distress tolerance skills
and emotional regulation techniques. Forensic art therapy is another approach that draws on
psychoanalytic theories to help individuals access the conscious and subconscious to safely
express emotions in a contained environment (Wassall and Greener, 2016). Developing
these containment skills can contribute to a “holding environment” and help build women’s
resilience for more intensive psychological work. The concepts of “holding” and “containment”
are also in line with the Royal College of Psychiatrists’ Enabling Environment initiative, which
particularly highlights the value of connectedness and belonging ( Johnson and Haigh, 2011;
Guthrie et al., 2017). Many forensic settings are working towards achieving Enabling
Environment status and this can also contribute to the women feeling contained when
undertaking therapeutic work.
As noted, in many cases, preliminary stages of treatment with violent women often involves
building therapeutic relationships, containment and helping the woman develop psychological
skills to manage more intensive psychological work. As treatment progresses, psychological
intervention can begin to focus more on increasing insight and reflection (Kernberg et al.,
2008). Drawing from psychoanalytic thinking, Bion (1962) presents psychopathological
problems as linked to a breakdown in the ability to think (Bion, 1962). This difficulty
links to problems with mentalisation, which results in problems reflecting upon personal
thoughts and feelings and difficulties empathising with others (Bateman and Fonagy, 2006).
Therefore, as treatment progresses, it is incredibly important to help develop the woman’s
ability to mentalise and reflect upon her thinking. This importance is particularly emphasised by
the fact the empirical findings that suggest insight deficits link to women’s risk of future
violence (Strub et al., 2014). Developing insight and mentalisation skills can be undertaken
through a formal mentalisation-based therapy (MBT) (Bateman and Fonagy, 2004), and
there are some preliminary findings indicating the promising findings with violent offenders
(Yakeley and Williams, 2014).
Increasing insight and ability to mentalise can also be identified as a treatment goal in other
existing therapies currently implemented with violent female offenders, such as the Life Minus
Violence – Enhanced ® programme (Ireland et al., 2009). Recent research highlights the
importance of integrating various aspects of different therapeutic approaches when working with
complex forensic populations (Ireland and Hansen, 2015). Therefore, incorporating
psychoanalytic concepts such as mentalisation into formulation, supervision and existing
JOURNAL OF CRIMINOLOGICAL RESEARCH, POLICY AND PRACTICE
therapeutic approaches is likely to be of value. Monitoring dynamics and considering the
possibility of enactments within these interventions is also likely to be of great value (Wallin, 2015).
In community and custodial settings, the Offender Personality Disorder Strategy for Women has
resulted in an expansion of services available for violent female offenders. Although many
interventions within the pathway are cognitive-behavioural in nature, the value of psychoanalytic
input with specialist forensic female populations has also been recognised (McGauley and
Bartlett, 2015). For example, MBT has been introduced in some services. Cognitive analytic
therapy (CAT) is also available in some settings. Further interventions across the pathway
include group interventions such as the Life Minus Violence – Enhanced ® programme (Ireland
et al., 2009), Women and Anger intervention and Firesetting Intervention Programme for
Mentally Disordered Offenders (Gannon and Lockerbie, 2011). Trauma-related treatment
needs are also addressed through treatment such as Eye Movement Desensitization and
Reprocessing. Individual offence-focussed and individual therapeutic interventions such
as schema therapy and trauma work are also offered when formulation has guided that this
modality would be most responsive to the presenting woman’s needs (Cooper and Hodgson,
2014). Across the pathway, women generally undertake psychological skills-based work prior
to engaging more intensive interventions.
Psychodynamic supervision has also been introduced in the Primrose Service, which is the
national provision for female personality disordered offenders in custody. This supervision setting
allows the multi-disciplinary team to discuss psychodynamic concepts to inform understanding
and formulation of the individual’s presentation. Anecdotal indications have suggested that
psychoanalytic supervision has been a valuable addition in this setting to inform formulation and
reflect upon treatment. This is also encouraging, given findings that psychoanalytic supervision
can also reduce staff burnout (Carruth, 2006).
Ways forward
In forensic settings, psychoanalytic input is often relatively rare. With a complex client group, such
as violent women, psychodynamic concepts can add an additional dimension into formulation,
supervision and treatment approaches. Examining the meaning of violence perpetrated by the
woman, communications of such violence, as well as enactments, can improve practitioner’s
depth of understanding. Formulation and the therapeutic process can also be greatly informed by
an increased awareness of psychodynamic process including transference, countertransference, splitting and projections. Anecdotally, psychoanalytic supervision seems to be of
particular value to services working with this population. There is, however, an overwhelming lack
of research examining the effectiveness of psychoanalytic input and this is a clear limitation. Staff
teams can also find it challenging at times to grasp the complexity of psychodynamic terminology
(Andersson, 2008).
Empirical research examining the benefits of psychoanalytic supervision would be extremely useful
to explore the impact on formulation, treatment approaches, treatment effectiveness, staff
well-being and staff retention (Watkins, 2013). This research would be of value to explore with both
male and female forensic populations. Although it is encouraging that there are evaluations of MBT
groups with female patients (e.g. Bateman and Fonagy, 2009), it would be greatly developed by
further evaluation with forensic female populations. Further evaluation of art therapy and CAT with
this population would also be of value. As a whole, violent female offender interventions are sparsely
researched, and methodological limitations, such as small sample sizes, present challenges for
evaluations. Considering methodologies responsive to smaller sample sizes may help examine the
effectiveness of psychoanalytic input with services working with violent women. An increased
understanding of effectiveness is likely to be of great value, and the potential of improving
understanding of such a complex client group is likely to be of even greater value.
Note
1. Prison listeners are part of the Listener Scheme developed and introduced by the Samaritans in 1991 to
help reduce self-harm and risk of suicide. Listeners receive training and provide emotional support to
other prisoners who are struggling to cope.
JOURNAL OF CRIMINOLOGICAL RESEARCH, POLICY AND PRACTICE
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Corresponding author
Annette McKeown can be contacted at: annette.mckeown@nhs.net
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