1. Empathy as a Determinant of Therapeutic Outcomes in Mental Health
Palmer Reg Orovwuje
Consultant Forensic Social Worker & Professional Leader
Forensic Mental Health Service
Wellington, New Zealand

2. Empathy definition Freud Stern Rogers Gellese Baron-Cohen
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

3. Cognitive empathy Acquiring & processing information
Better understanding
Has important affective components
Not subjective emotional sympathy
Influential in social relationships
Effective communication
Basis for our moral code
Ensures inhibition of aggression

4. 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 with
human relationships and experience
subjective aspects of reality

5. 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 groups
biological conditions of illness
insight
history of violence
lack of remorse
non-compliance
formulation of multiple hypothesis
drive judgements & opinions

6. Empathy spectrum Zero/reduced empathy Empathy erosion borderline
psychopathic personality disorder
schizophrenia
alcohol abuse
fatigue, depression
Empathy erosion
corrosive emotions
revenge
bitter resentment
blind hatred
desire to protect

7. 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

8. Conflict in forensic mental health service
Creates conflict
Reduces empathy
Care, nurture, cure
Control, restraint
Public safety, inquiries
Conflicting philosophies
Criminal justice vs mental health

9. Patient “Bob” case study
Index offence: murder
Sentence: not guilty by reason of insanity

10. Background- early years
Migrated 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

11. Background – teenage years
Changed behaviour at first year at college
Abusing alcohol , using cannabis
Oppositional, irritable, confrontational
Break up of relationship
Hearing voices, auditory hallucination
Presented for psychiatric assessment
Thought disordered, deluded, auditory hallucinations
Anti-psychotic medication prescribed
Background – teenage years

12. 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

13. Patient: empathy from Pacific staff was main reason for change
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

14. 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

15. Conclusion Understand how society works
Law, systems
Recognise and understand differences
Build adaptable services
Responsive
With empathy

16. Empathy as a Determinant of Therapeutic Outcomes in Mental Health
Palmer Reg Orovwuje
Consultant Forensic Social Worker & Professional Leader
Forensic Mental Health Service
Wellington, New Zealand