Therapeutic Relationships & Boundary Maintenance: The Perspective of Forensic Patients Enrolled in the Aggressive Behaviour Control Program

The complexity of the therapeutic relationship is amplified when the setting is a prison and the patient is incarcerated. A challenge essential to the therapeutic process is the establishment and maintenance of a therapeutic relationship, including therapeutic boundaries (Petemelj-Taylor, 1998). Theoretical and empirical literature related to boundaries in the therapeutic relationship has focused primarily on outpatient settings where the therapeutic relationship demands only one role from the mental health professional- that of therapist. Conversely, the therapeutic relationship in the inpatient setting with a forensic patient demands that the mental health professional occupy multiple roles all within the realms of the therapeutic relationship. Although existing knowledge may provide some guidance, the complexity of therapeutic relationships with forensic patients has not been adequately addressed in either theoretical or empirical literature. Developing an understanding of the complexity of maintaining therapeutic boundaries with forensic patients is essential to guide nurses and other professionals in their therapeutic relationships with this group of patients. To extend current knowledge about therapeutic relationships and therapeutic boundary maintenance with the incarcerated forensic patient, the focus of this study was the exploration of the perspectives of forensic patients enrolled in the Aggressive Behaviour Control (ABC) Program. The study was conducted using a naturalistic inquiry research design (Lincoln & Guba, 1985). Data was collected through indepth interviews with 12 participants enrolled in the ABC program. All participants were given an opportunity to review, confirm, clarify, correct, amend or extend the interview transcripts and the elements identified in analyzing the data they provided. Field notes, reflective journal entries, and interview transcripts constituted the data for analysis. Analysis of the data collected revealed a core process - the development of "therapeutic" relationships - indicating that the development of "therapeutic" relationships was a complex process. Associated with this process were five interrelated themes. Adjusting to the House, describes the participants' transition from their parent institutions to the treatment environment. Knowing the Fundamental Structures of the House, provides the participants' perception of the influential contextual factors in the treatment environment. Evaluating the Primay Therapist as a Guide, describes the process that the participants engaged in to determine the approach to treatment of the primary therapist. Experiences that Promote or Hinder the Relationship, described those experiences that the participants had with the primary therapist that either promoted or hindered "therapeutic" relationships. Finally, Ways of Being with the Primary Therapist: Head, Heart, Head and Heart, and Wallet depicted four different types of relationships that evolved between the participants and the primary therapists