Relating Following Aggression - Women's Medium Secure Services

Background: Women in medium secure services can present with aggressive behaviours and a high level of risk to self and others. Research suggests frontline staff are frequently the victims of, or witness to aggression by forensic inpatients. The therapeutic relationship is proposed as central to therapeutic outcome, but may be jeopardised by inpatient aggression. Staff perceptions of the therapeutic relationship and aggression have not been explored in women’s medium secure services. The study aimed to develop a theoretical model grounded in frontline staff perceptions of the therapeutic alliance and aggression in a women’s medium secure services. Method: The data from 13 semi-structured interviews conducted with frontline staff was analysed using Constructivist Grounded Theory methods. Results: The tentative descriptive theoretical model “Relating Following Aggression” emerged from the interview data. Contextual information supports five core categories, and the related sub-categories. The findings propose the therapeutic relationship is intrinsically linked to boundaries, and boundary violations could result in relational deterioration. Aggression affected the emotional and psychological wellbeing of the participants, and compromised the staff-patient relationship. The participants were fearful of aggression occurring in their workplace which resulted in them spending less time with the women and withdrawing from the therapeutic relationship. Conclusion: The findings reveal the complexity of the frontline staff-patient relationship in women’s services. Aggression occurring between frontline staff and women can seriously compromise the therapeutic relationship through a crossing of the boundary line and a perceived breach of trust. Greater support for both the frontline staff and women is required. Future research is recommended. Keywords: Frontline staff, women, aggression, forensic, therapeutic relationship, Constructivist Grounded Theory.