Bridging the Gap between Forensic and General Clinical Practice: Working in the "here and now" with difficult schema modes

In this chapter, the authors discuss some of the challenges of working with schema modes in forensic patients, and how to overcome them. They begin by presenting some of the main schema modes prevalent in forensic populations: the Bully and Attack, Conning Manipulator, Paranoid Overcontroller, Self-Aggrandiser and Predator modes, including a review of the research evidence regarding the prevalence of these modes in forensic settings and their link to violence and recidivism. The authors then present an interactive model, which explicates the effects of these modes on other people, such as the personnel in the institutions in which these patients reside. The model proposes that it is the interaction between patients’ modes and the reactions of treatment providers – that is, the modes which are triggered in reaction to patients’ modes – that are responsible for many of the impasses in therapy. The authors also explore the presence of these ‘forensic’ modes (in less severe forms) in the general clinical population and outline effective methods for working with these modes in both types of setting.