Empathy as a Determinant of Therapeutic Outcomes in

Mental Health

Palmer Reg OrovwujeConsultant Forensic Social Worker & Professional LeaderForensic Mental Health Service Wellington, New ZealandReg.Orovwuje@ccdhb.org.nz

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

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

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

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

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

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

Conflict in forensic mental health service•Care, nurture, cure•Control, restraint•Public safety, inquiries

•Conflicting philosophies•Criminal justice vs mental health

PATIENT “BOB” CASE STUDY

Index offence: murderSentence: not guilty by reason of insanity

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

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

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

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

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

Conclusion• Understand how society works– Law, systems

• Recognise and understand differences• Build adaptable services– Responsive– With empathy

Empathy as a Determinant of Therapeutic Outcomes in

Mental Health

Palmer Reg OrovwujeConsultant Forensic Social Worker & Professional LeaderForensic Mental Health Service Wellington, New ZealandReg.Orovwuje@ccdhb.org.nz