A Theoretical and Empirical Review of Dialectical Behavior Therapy Within Forensic Psychiatric and Correctional Settings Worldwide

ABSTRACT

Cognitive-behavioral programs which are structured, skills-based, and risk-focused have been found to reduce recidivism rates by up to 55%. Dialectical behavior therapy (DBT) exemplifies all of these components, and has been rapidly adapted and implemented in correctional and forensic psychiatric facilities worldwide to reduce recidivism. Regrettably, the widespread implementation of adapted DBT has outpaced the research on its effectiveness for this purpose. Thus, it is currently unclear whether these programs are meeting the rehabilitation needs of these systems. In the following article, a qualitative systematic literature review of all DBT programs within forensic psychiatric and correctional populations using the PRISMA statement guidelines is presented, along with a detailed exploration of how these programs align with best practices in offender rehabilitation, and whether they are effective in reducing recidivism risk. Results offer very preliminary evidence that DBT has the potential to reduce recidivism risk in criminal justice systems if applied within a Risk-Need-Responsivity framework.

KEYWORDS:

• Criminal justice policy
• dialectical behavior therapy
• DBT
• offender rehabilitation
• systematic literature review

Acknowledgments

I owe a debt of gratitude to Dr. Peter Hoaken and Dr. Alan Leschied for guiding me to relevant literature, synthesizing my ideas, and offering me invaluable guidance in the beginning stages of this article. I extend my sincerest thanks to Dr. David Dozois and Dr. Graham Reid, and, again, Dr. Alan Leschied, for your unwavering support and your ongoing guidance through the editing and polishing stages of this document. I thank Stephanie Montgomery-Graham for providing astute feedback and important suggestions. I want to acknowledge Joshua D. Wright for assisting with editing this document. Last, but certainly not least, I offer my deepest thanks to Rachel Goldberg and Sally Zheng for helping me review this literature.

Notes

¹ The term “offender” is used to refer to anyone who has committed a criminal act, whether they are criminally responsible or Not Criminally Responsible on Account of a Mental Disorder (Criminal Code, R.S., 1985, c. C-46, s. 16).

² Correctional facilities include all custodial environments (e.g., jails, prisons) where individuals who are criminally responsible serve their sentences. Forensic psychiatric facilities are psychiatric hospitals for individuals who have committed a crime and been found Not Criminally Responsible on Account of a Mental Disorder, or Unfit to Stand Trial (Criminal Code, R.S., 1985, c. C-46, s. 16).

³ Unfortunately, the quality of English in this manuscript is poor, making the study difficult to understand. For example, their concluding statement is “I venture to say that the high anxiety and lack of effective short-term treatment offered in patients with such personality traits and environmental groups, the expected off is not a subjective” (Asmand, Mami, & Valizadeh, 2015). The authors of this article did not respond to emails seeking clarification on their study.