Prospects for curing people with serious personality disorders who have committed crimes: a therapeutic-rehabilitation program in a state health supported protected residential facility

Abstract

The authors describe the therapeutic-rehabilitative program supported by the National Health Service that a young man suffering from serious personality disorders, “narcissistic” and “borderline”, took part in at a protected residential psychiatric facility (Centro di Riabilitazione ‘Villa San Pietro’, Arco, TN, Italy). The young man had attempted suicide 4 times, once very seriously, and had repeatedly committed a serious crime that resulted in his being sentenced to 4 years in prison on a plea bargain. Following an initial period spent in prison, he was ordered by the Court to be sent to a Rehabilitation Community where he was under house arrest as recommended by the Head of the Department of Mental Health in the province where the man resided. The first part of this paper gives a detailed description of the young man's personal and clinical background, which represents the basis for a thorough comprehension of the guidelines and dynamics of the therapeutic-rehabilitative program designed for him. He followed the program for two years, which is amply illustrated in the second part of this report. The specific and non-specific therapeutic instruments used or applied in the program are described. The non-specific instruments refer to the particular structural and organizational features of the Villa San Pietro Clinic: high level of protection and security as well as a large number of patients. The specific instruments concern a specialized rehabilitative methodology which rotates around three psychotherapists, each with a well-defined role in working with the patient. There is only slight mention of psychiatric drugs and integrated rehabilitative activities, such as vocational training, expression and socialization activities, as these are frequently available in most psychiatric Rehabilitation Centres. We have described in detail, however, the psychotherapeutic techniques of the cognitive-behavioral type, which were particularly important in the therapy program planned for this individual. The peculiar aspect of the therapeutic path followed by our patient in the Rehabilitation Center was the fact that the man continually took part in the treatment in all its aspects. In regards to this, we point out the importance of having a house arrest during the first months of recovery and until a full therapeutic alliance had been achieved. This was a circumstance that allowed the young man to come voluntarily to the clinic to participate in the rehabilitative program until its positive conclusion, even after the unexpected judicial decision to grant him a pardon. This pardon, however, created a dramatic conflict for the patient, which he was able to overcome on his own in a short time, by using his acquired strategies for coping (described in detail). Some  months after discharge patient shows a good recovery and stable clinical conditions. He’s constantly attending the Mental Health State Centre and he’s steadily followed by a psychologist undergoing regular psychiatric valuations. He’s now living at home with his parents actually following pharmacologic therapy with no relational or behavioural problems. Still is in progress a closely planned program of progressive coming back to work.