Kingsley Norton

This groundbreaking book explores the psychodynamics and socio-politics of the forensic therapeutic milieu, addressing some of the most difficult and complex issues facing practitioners. It sets out a psycho-social framework for understanding the predicament and the needs of those who live in and those who work in forensic mental health settings. It brings to life the thinking of those working on the frontline in an increasingly difficult and hostile environment, and draws together fresh and stimulating approaches to engagement with highly complex individuals who present challenges to traditional models of psychiatric assessment and treatment.Contributors with considerable clinical experience and expertise from a range of disciplines consider the ethical, emotional and intellectual challenges of their work, and describe ways in which genuine containment and change can be achieved despite numerous perceived assaults on therapeutic relationships, and on the therapeutic milieu itself. Combining clinical case studies with organisational perspectives and clear descriptions of theoretical processes, they explore key issues including the challenges of maintaining role-appropriate, 'boundaried' relationships; the tensions between public protection and individual confidentiality; questions of risk and responsibility; duty of care and respect for individual liberty; the challenges posed by inter-professional tensions and rivalries; as well as specific clinical dilemmas. The difficulties they experience in fulfilling specific therapeutic roles in the face of uncertainties about the funding and commissioning of their services are addressed, and the final part of the book outlines some of the ways in which individuals, particular services and whole organisations may protect themselves when under attack.This unique and highly original book is essential reading for all those working, or training to work, in both forensic and non-forensic inpatient therapeutic milieux and for academics and lay readers interested in the societal dynamics of inclusion and exclusion that are replicated and magnified in these settings.

This guide for setting up a clinical service in the National Health Service is based on the author's experience of leading a nationally funded project to develop two new specialist services in different parts of the country and involving three separate NHS Trusts.The project successfully delivered two services for personality disordered patients based on the template of Henderson Hospital, a democratic therapeutic community (TC). Kingsley Norton takes the reader, step-by-step, through the entire process of setting up these new services. Unpacking Henderson Hospital's complex interpersonal environment into its ideological, 'cultural' and structural constituents, a development team that included ex-service users from Henderson used these ingredients to imprint the TC model in the newly recruited staff teams. The two replicated products were further supported and evaluated by the development team during their first 18 months of operation. The author reveals the complexity of the developmental task and shows that the process was never a case of 'just adding water'.Dr Norton's wealth of hands-on experience and practical advice makes this book essential reading for anyone interested in management and the NHS or public services and attempting to innovate. It is also useful for those wanting to understand more about TCs and how they operate as institutions.

`[In this book] "difficult clients" is meant as "difficulties with clients"... I like to be challenged in my thinking and there was much about this book that I found thought-provoking and challenging, and which made me re-examine my basic philosophy and approach to counselling... For the newly trained counsellor this book offers organizational, practical and theoretical advice... it gives a good academic overview of understanding how client-counsellor interactions can become difficult, together with some preventative techniques and case-work examples' - Counselling, The Journal of The British Association for Counselling Counsellors and other mental health professionals will inevitably encounter clients who are difficult to work with because they do not comply with the basic requirements of forming a trusting relationship and accepting help or advice. Such clients can place an enormous strain on those who try to help them. This book sets out practical guidelines, backed up by examples and a sound theoretical base, for the management of these difficult, disturbed or disturbing clients. The authors concentrate on the everyday difficulties of the transaction between practitioner and client in their respective social contexts, rather than locating the problems solely within the client, and indicate ways in which these difficulties can be successfully overcome.

`[In this book] "difficult clients" is meant as "difficulties with clients"... I like to be challenged in my thinking and there was much about this book that I found thought-provoking and challenging, and which made me re-examine my basic philosophy and approach to counselling... For the newly trained counsellor this book offers organizational, practical and theoretical advice... it gives a good academic overview of understanding how client-counsellor interactions can become difficult, together with some preventative techniques and case-work examples' - Counselling, The Journal of The British Association for Counselling Counsellors and other mental health professionals will inevitably encounter clients who are difficult to work with because they do not comply with the basic requirements of forming a trusting relationship and accepting help or advice. Such clients can place an enormous strain on those who try to help them. This book sets out practical guidelines, backed up by examples and a sound theoretical base, for the management of these difficult, disturbed or disturbing clients. The authors concentrate on the everyday difficulties of the transaction between practitioner and client in their respective social contexts, rather than locating the problems solely within the client, and indicate ways in which these difficulties can be successfully overcome.

When patient meets doctor, as well as engaging in a transaction with a clinical purpose, they react to one another as people. Their personalities and ability to make relationships in general also affect the professional interaction. As with other relationships, things can go wrong. The outcome of the consultation may not then be what was hoped for or intended on either side. This book considers the factors which may cause problems in the doctor-patient relationship, emphasising and explaining the often unconscious personal aspects of doctor and patient within a model studied from various perspectives. Through this insight doctors can be helped to manage their interactions with patients within their own consultational style, thereby avoiding many unnecessary professional relationship problems. This analysis, which is well-illustrated by clinical case vignettes, is sure to be welcomed by clinicians, trainees and course organisers in all areas where communication between individuals plays an important role.

When patient meets doctor, as well as engaging in a transaction with a clinical purpose, they react to one another as people. Their personalities and ability to make relationships in general also affect the professional interaction. As with other relationships, things can go wrong. The outcome of the consultation may not then be what was hoped for or intended on either side. This book considers the factors which may cause problems in the doctor-patient relationship, emphasising and explaining the often unconscious personal aspects of doctor and patient within a model studied from various perspectives. Through this insight doctors can be helped to manage their interactions with patients within their own consultational style, thereby avoiding many unnecessary professional relationship problems. This analysis, which is well-illustrated by clinical case vignettes, is sure to be welcomed by clinicians, trainees and course organisers in all areas where communication between individuals plays an important role.