TOM and forensic sand play therapy in a high security hospital

Abstract

The Therapy Outcome Measure (TOM) was used to assess the impact of individual forensic sandplay sessions in one of three high-security psychiatric hospital settings in England and Wales that provides forensic health care to adults who are considered to pose a grave danger to themselves or to members of the public. Forensic sandplay has been developed for the first time in the UK and wider afield in order to suit low, medium and high secure institutions, security, and high-risk behaviours (Allen, 2018). This single case study took place over a 28-month period, where 66 sessions using 40 sand trays were conducted with an adult male patient who had committed matricide and violence towards women. This patient was considered to have treatment engagement difficulties associated with memory deficits, emotional (and experiential) avoidance (with fears of stress triggering seizures). Over-control, superficial engagement and a lack of insight were additional difficulties. This patient was rated using the adapted TOM scale developed by Rampton (TOM Adapted Scale 7, Challenging Behaviour and Forensic Mental Health) every six weeks. Impairment, Activity and Participation scales all showed a 40% increase. The Wellbeing and Distress scale showed a 60% increase. Results showed an impact upon reducing suicidal ideation and in preparing the patient for mandatory violent offending treatment. Sandplay imagery was noted to be calmer and more balanced alongside decreased aggression in the patient. Reference: Allen, E. (2018). Introducing Forensic Sandplay Therapy, British Journal of Play Therapy, 13, 50-64.