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Empathy as a Determinant of Therapeutic Outcomes in
Mental Health
Palmer Reg OrovwujeConsultant Forensic Social Worker & Professional LeaderForensic Mental Health Service Wellington, New [email protected]
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Empathy definition
Freud theories of developmental psychology
Stern the interactional synchrony of mother and infant
Rogers seeing completely through client eyes
Gellese to place ourselves in the mental shoes of others
Baron-Cohen a neural matching mechanism
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Cognitive empathy
Acquiring & processing
information Better understanding
Has important affective
components
Not subjective emotional sympathyInfluential in
social relationships
Effective communication
Basis for our moral code
Ensures inhibition of aggression
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Conflicts with bio-medicine
• Scientific• Clinical distance• Detached and measured• Objective medical decisions• Protects clinicians from being overwhelmed• Protects patients from professional bias
BUT this conflicts withhuman relationships and experience
subjective aspects of reality
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Psychiatric assessment
Assessments
dangerousness
work with people from
different ethnic groups
competence and capacity
little published
evidence on validity of
risk assessment instruments
in various ethnic groupsbiological
conditions of illness
insight
history of violence
lack of remorse
non-compliance
formulation of multiple
hypothesis
drive judgements &
opinions
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Empathy spectrum
Zero/reduced empathy• borderline• psychopathic personality
disorder• schizophrenia• alcohol abuse• fatigue, depression
Empathy erosion• corrosive emotions• revenge• bitter resentment• blind hatred• desire to protect
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Forensic mental health services
• Non-white / indigenous people– Globalization, colonization and mass immigration– “triple jeopardy”: non white, mentally ill, offending– Excluded from society– Racism– High negative statistics– Conflicting values and belief systems
• Diverse populations• Women offenders• Learning difficulties
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Conflict in forensic mental health service•Care, nurture, cure•Control, restraint•Public safety, inquiries
•Conflicting philosophies•Criminal justice vs mental health
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PATIENT “BOB” CASE STUDY
Index offence: murderSentence: not guilty by reason of insanity
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Background- early yearsMigrated from Pacific Nation with
large family to New Zealand
Family settled in low income Pacific immigrant community
Traditional beliefs, language, religion
Settled, amenable, popular at primary school
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Background – teenage years
Anti-psychotic medication prescribed
Thought disordered, deluded, auditory hallucinations
Presented for psychiatric assessment
Hearing voices, auditory hallucination
Break up of relationship
Oppositional, irritable, confrontational
Abusing alcohol , using cannabis
Changed behaviour at first year at college
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Index offence• Head on collision - driving fast, overtaking,
hallucinations, alcohol, cannabis• Killed other driver• Not guilty by reason of insanity• Admitted to medium secure unit• Demanding Pacific staff as main key worker
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Transferred to minimum secure unit
High numbers of Pacific staff
Key worker was Pacific
Stopped smoking
cigarettes
Stopped using
substances
Settled mental state
Full compliance
with treatment
regime
Patient: empathy from Pacific staff was main reason for change
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Role of forensic social workers
• Empathy=central legacy of social work• Uniquely placed• Interface of legal and service systems• Work across many professional boundaries• Advocates in clinical practice– for Empathy– against Empathy Erosion
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Conclusion• Understand how society works– Law, systems
• Recognise and understand differences• Build adaptable services– Responsive– With empathy
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Empathy as a Determinant of Therapeutic Outcomes in
Mental Health
Palmer Reg OrovwujeConsultant Forensic Social Worker & Professional LeaderForensic Mental Health Service Wellington, New [email protected]