The social relationships that a prisoner detained under hospital order enters into can help predict the chance that he will reoffend. This has been revealed by research conducted by sociologist Ruud van der Horst for which he will be awarded a PhD on 7 November 2011 by the University of Groningen.
Van der Horst examined hundreds of relationships of prisoners held on five wards at the Dr S. van Mesdag Forensic Psychiatric Centre (FPC) in Groningen. The ‘choices’ that imprisoned psychiatric patients make regarding their friendships, their ‘business’ acquaintances, and in equal and unequal relationships, all have something to say about their understanding of problems, their ability to control their impulses and their skills. The latter three areas in turn are related to the chance that a released prisoner will reoffend. Van der Horst: ‘This knowledge means that we can better judge whether someone is still a threat to society. In addition, influencing their behaviour with regard to relationships can be used as an instrument in their treatment.’
The most important grounds for the system of detaining prisoners under hospital order is civilians’ security. This is why forensic psychiatric patients are held for longer periods of time and receive psychological treatment. Yet these prisoners still often commit new crimes, either out on leave or after release. This has led to pressure from politicians to have their danger of reoffending assessed properly.
It was already known that social relationships influence behaviour and wellbeing. This holds even more true for someone with a personality disorder. Van der Horst therefore investigated these patients’ relationships in the clinical setting, taking as starting point that this would be a true reflection of how a patient is doing: ‘If for instance you see that someone is establishing fewer relationships that fall under healthy behaviour, or is becoming increasingly unfriendly, or only uses others, or lets himself be influenced to a high degree, you can be quite certain that the patient is not developing properly. This could perhaps be a point in time to intervene and put someone into another social setting.’
Van der Horst had previously worked for two years as a researcher at the Van Mesdag FPC. This was when the groundwork was laid for his PhD research. On five wards he investigated all the one-on-one relationships the various patients had, basing himself on staff judgement, and employing Social Network Analysis. For each ward, and for each kind of relationship, this resulted in a chart with twelve dots representing the patients, connected by lines indicating relationships. ‘There are many different kinds of relationships. These can be friendships but can also be purely instrumental ones, where one person is using the other. Another type are relationships involving trust or influence. So it’s not only about who is drawn to whom, but also about the nature of the interaction. It’s also important to uncover the entire field of relationships as this provides insight. By taking the time to consider the relationships, staff became more aware of the relationship context of patients’ behaviour.’
Van der Horst also examined whether or not the characteristics of ten personality disorders were apparent in patients’ social interaction. This often proved to be the case: patients with an antisocial personality disorder had more hostile, influencing and instrumental relationships . At times Van der Horst was in for a surprise. ‘You would expect that narcissists who are normally impulsive and competitive would be hostile and macho. However, because they were all on the same ward together the atmosphere there was actually quite friendly and laid-back.’
Patients’ social networks, the people they seek out or are prone to avoid and the way they interact are not directly related to the danger of reoffending, but are so indirectly. Three variable factors are influenced which are seen as determining how the danger of reoffending can be assessed: awareness of own problems, the degree of control over impulsive behaviour, and social and other skills. These are also the three major factors that FPC treatment focuses on. The latter two factors in particular turn out to be strongly related to the social relationships that a patient is engaged in. These are also the domains where intervention is first targeted. The intervention is meant to lead to changes in behaviour which reflect that patients are aware of their own problems.
Van der Horst expects that this knowledge will provide FPCs with another useful instrument to help carry out their job. ‘Problem behaviour can now be recognized more specifically and other staff than just the behavioural specialists will now be able to do so. It could well be an instrument that could become part of the regular treatment in an FPC.’
Ruud van der Horst (Leiderdorp, 1975) studied sociology at the University of Groningen and worked from 2003 until 2005 as a researcher at Dr S. van Mesdag FPC in Groningen. He conducted his PhD research at the University Center for Social Science Theory and Methodology (ICS). He has been working at the Ministry of Justice’s Research and Documentation Centre since January 2010. He will receive his PhD from the Faculty of Behavioural and Social Sciences for his thesis entitled 'Network effect on treatment results in a closed forensic psychiatric setting.' His supervisor was Prof. T.A.B. Snijders and co-supervisor Dr M. Spreen.
Contact: Ruud van der Horst, e-mail: r.p.van.der.horst rug.nl
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