Fatal torment – From psychosis-driven index offence to trauma: A case study in forensic psychotherapy,trauma therapy and matricide

Abstract

Objective:

This paper presents the case of a forensic inpatient who was found ‘Not Guilty by Reason of Mental Illness’ for the murder of his mother and illustrates how psychotic symptoms can mask trauma symptoms, leading to neglect in the treatment of trauma in psychotherapy with forensic inpatients.

Method:

A case study of a forensic inpatient diagnosed with schizophrenia that as part of his rehabilitation program received 19 sessions of therapy (i.e. grief counselling, Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and imagery rescripting). The following measures were administered pre- and post-treatment: (a) The Depression Anxiety Stress Scale (DASS), to measure symptoms of depression, anxiety and stress; (b) The Impact of Events Scale-Revised (IES-R), to measure post-traumatic stress symptoms; and (c) The Trauma Attachment and Beliefs Scale (TABS), to measure disruption in beliefs about self and others.

Results:

At completion of therapy, he showed a reduction in Post-Traumatic Stress Disorder (PTSD), depression, anxiety and stress symptoms.

Conclusions:

Trauma and PTSD-related symptoms in the forensic inpatient population must be assessed and treated alongside psychotic symptoms, where relevant. TF-CBT was effective in reducing PTSD symptoms in this current case study and should be considered as an intervention in forensic inpatient populations.

Keywords

cognitive behavioural therapy forensic inpatients matricide post-traumatic stress disorder psychosis schizophrenia trauma trauma therapy

Get full access to this article

View all access options for this article.

References

Grubaugh

Zinzow

Paul

. Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: A critical review. Clin Psychol Rev 2011; 31: 883–899.

Putts

. Recognizing trauma and posttraumatic stress disorder symptoms in individuals with psychotic disorders. J Counsel Development 2014; 92: 83–89.

Berry

Ford

Jellicoe-Jones

. PTSD symptoms associated with the experiences of psychosis and hospitalisation: A review of the literature. Clin Psychol Rev 2013; 33: 526–538.

Berry

Ford

Jellicoe-Jones

. Trauma in relation to psychosis and hospital experiences: The role of past trauma and attachment. Psychology and Psychotherapy: Theory, Research and Practice 2014. Available at: http://dx.doi.org/10.1111/papt.12035 (accessed 12 November 2014).

Gray

Carman

Rogers

. Post-traumatic stress disorder caused in mentally disordered offenders by the committing of a serious violent or sexual offence. J Forens Psychiatry Psychol 2003; 14: 27–43.

Fowler

. Understanding the outcome findings of CBT for psychosis: A cognitive model and its clinical implications. In: Cognitive therapy for psychosis conference, Ayr, Queensland. 23–24 November 2000.

Lovibond

. Manual for the depression anxiety stress scales. Sydney: Psychology Foundation, 1995.

Weiss

Marmar

. The Impact of Event Scale - Revised. In: Wilson

Keane

(eds), Assessing Psychological Trauma and PTSD: A Practitioner’s Handbook. New York: Guilford Press, 1997, pp. 399–411.

Creamer

Bell

Failla

. Psychometric properties of the Impact of Event Scale - Revised. Behav Res Ther 2003; 41: 1489–1496.

10.

Pearlman

. Trauma and Attachment Belief Scale. Los Angeles: Western Psychological Servcies, 2003.

11.

Foa

Gillihan

Bryant

. Challenges and successes in dissemination of evidence-based treatments for post-traumatic stress: Lessons learned from prolonged exposure therapy for PTSD. Psycholog Sci Public Interest 2013; 14: 65–111.

12.

Arntz

Sofi

Van Breukelen

. Imagery Rescripting as treatment for complicated PTSD in refugees: A multiple baseline case series study. Behav Res Ther 2013; 51: 274–283.