Análisis de los Índices

Considering first the whole sample, the findings o f the current study highlight the existence o f a considerable level o f psychopathology in a prison sample. This in turn has implications for the role o f psychological services in providing assessment, diagnosis, and treatment to a large number o f people, as well as for the provision o f education and training to those involved in their direct care and rehabilitation. However, as well having implications for the way in which this population is managed and cared for, it also raises important questions about the role and likelihood o f rehabilitation for people in prisons. It seems unlikely, for example, that proper and effective rehabilitation can take place if the contribution o f Axis II disorders is not fully, or even partially, considered. Further, it is widely held that that people with personality disorders are extremely difficult to treat. If the concept o f treatability is extended to include the notion o f rehabilitation (of criminal behaviour), it seems plausible to argue that the presence o f personality disorders may seriously undermine the likelihood o f successful offender rehabilitation.

This has implications for the proposed ‘dangerous and severe personality disorder’ (DSPD) bill (Home Office/ Department o f Health, 1999). W hilst it is no doubt important and appropriate to in some way regulate the behaviour o f those at risk o f committing serious and dangerous crimes, arguably research such as that reported here suggests that the scale o f the problem is wider than many people would care to think. The finding that remand and unsentenced prisoners show high levels o f clinical depression may also have a number o f implications for this bill. Plausibly, people with personality disorders find it particularly difficult to cope with uncertainty, especially when skills such as emotional regulation are considered. Long periods o f uncertainty regarding their legal status, especially if they are being closely monitored for the purposes o f the DSPD bill, may pose particular difficulties.

Turning to consider findings specifically in relation to the self-injury group, a number o f points can be made. While the findings here that borderline personality pathology is prevalent amongst self-injurers may engender therapeutic pessimism, as highlighted earlier there is a growing body o f evidence indicating that symptoms o f this disorder can be effectively ameliorated using particular treatm ent approaches (e.g. Linehan, 1994; Bateman and Fonagy, 2001). Given the nature and severity o f BPD, however, confirmation o f the presence o f such pathology amongst does self-injurers does imply that straightforward techniques solely focused on symptom relief are unlikely to be sufficient to reduce ISI, at least in the longer term. Rather, findings here appear to support the need to develop specialist prison treatment programmes to address individuals’ broad ranging difficulties. Further, given that the constellation o f difficulties associated with BPD are considered to be relatively stable over time, it seems likely that the development o f such interventions would need to be complemented by and linked to community programmes if such problems are to be definitively addressed. Considering further the feasibility o f undertaking therapeutic work with self-injuring prisoners, a number o f additional observations support a degree o f cautious optimism in this respect. Firstly, many o f those with personality disorders who took part in the research demonstrated the ability to access and acknowledge some o f their dysfunctional beliefs. This suggests a potentially positive prognosis for cognitively-based interventions with a prison population, and highlights that the PBQ may be a relevant and valuable measure in a clinical context, even if it is beyond the scope o f this study to infer that it can predict specific personality disorders (although Beck et al.’s 2001 study suggested it was possible to do so for five o f the DSM-IV personality disorder diagnoses).

On a more interpersonal level, the author’s experience o f carrying out research with prisoners supports a rather optimistic view and expectation o f working with this population, who are often viewed in a negative light by clinicians. Negative perceptions are often perpetuated in the media, and there may be a role for clinical psychologists to play in addressing the widespread disdain that is held

for working both with prisoners and with people with personality disorders in general.

It is important to acknowledge, however, that the research process used in this study was not intrinsically challenging to prisoners, as would be the case with therapeutic work. Notwithstanding this, though, it was generally relatively easy to establish a useful rapport with the participants o f this study, and engage them in a process that involved a degree o f introspection.

Lastly, this study represents a quantitative snap shot o f these individuals at a particular time. In the case o f those with BPD, this may be particularly problematic, as such people are known to shift in and out o f more prototypical borderline presentations rapidly. It may well be the case that a follow up study, using a more qualitative approach would be equally informative. This approach could be used to examine the experiences of prisoners over a longer period o f time, with a particular focus on their perceptions o f their emotional and behavioural responses to their environments. The willingness o f individuals to talk openly about their experiences suggests that this would be a feasible endeavour. A qualitative study looking at staff attitudes towards self-injury and receptiveness to psychological accounts o f individuals problems would also be instructive, as this may itself begin to lay some o f the groundwork required for the development o f further treatment possibilities for this population.