From hatch to handshake

Abstract

This chapter presents a single case study from a high secure setting and describes collaborative, cross-disciplinary approaches of joint DBT and Art Psychotherapy sessions. The case study focuses on a man who as a child experienced sexual and physical abuse by his father following the death of his mother. The chapter is a continuation from ‘The Boy Who Cried Wolf’ (Allen, 2018), following on from sessions through a ‘hatch’ (a small window of the patient’s side room, or into a seclusion suite) to on the ward, and ending with a handshake; described by the patient as a “happy ending” where the patient was able to safely reconnect and get in “touch” with emotional regulation and distress tolerance. Both therapists (one female, one male) adopted a schema-informed approach where the gender-mixed dyad, along with offering joint three-way directives in image-making (e.g. drawing around each other’s hands) provided “symbolic contact” (Hunter & Struve, 1998) and a re-parenting dynamic to emerge. This triad of a 2:1 approach is explored by both authors using a psychodynamic, schema and DBT-informed framework, along with an examination of the joint imagery made in sessions that progressed towards using appropriate touch in conjuncture with other aspects of therapy, such as mindfulness and emotional regulation. Touching hands metaphorically through imagery provided “here and now” mindfulness techniques and a deepening of trust. This unique combination helped provide resolution of emotional experiences and containment and restoring a healthier way of relating to others; there was a marked reduction in violence and aggression during room and rub down searches and the administration of medication by nursing staff. The chapter concludes with recommendations and learning objectives for future practice, suggesting creative and innovative ideas about incorporating touch in forensic treatment approaches.