Founded in 1931, and now part of the Tavistock and Portman NHS Foundation Trust, the Portman Clinic is a small specialist NHS outpatient forensic psychotherapy clinic offering psychoanalytically informed assessment and treatment services for adults, adolescents and children who are troubled by problems of criminality, violence, problematic sexual behaviours, or anti-social personality disorder.
Patients accepted for assessment have usually acted on their sexual, criminal or violent fantasies; however, patients with violent or dangerous fantasies at risk of enactment may also be considered. The Portman’s clinical services are commissioned by NHS England, and we accept referrals throughout England and Wales from professionals of all disciplines, as well as self-referrals.
Patients may present with a range of unusual, abnormal, harmful or illegal behaviours including burglary and theft; deception and fraud; violence, including sexual violence; sadomasochism; exhibitionism and voyeurism; fetishism; compulsive use of adult and/or child internet pornography; paedophilia and incest. Children and adolescents may present with sexually inappropriate behaviour, delinquency, aggression and violence.
Patients must have some motivation to engage in treatment not only concerned with symptom relief but also in understanding the underlying conscious and unconscious motives to their behaviours. They will also need to be sufficiently stable to be treated in an out-patient setting without immediate access to in-patient facilities. However, we do see more disturbed patients if on-going liaison with general or forensic psychiatric services can be maintained. We will not accept patients for treatment with on-going active alcohol or substance misuse or patients who are currently involved in court proceedings, as this may affect their motivation for treatment.
Assessment and therapy
Individuals accepted for assessment can be seen for up to six meetings, during which the clinician, with the patient, will carefully decide whether they are suitable for one of the psychotherapeutic treatments that we offer – usually individual or group psychoanalytic therapy, but we also offer couple or family work. Therapy tends to be long-term and sessions are usually once weekly. Although there are many exceptions, our experience is that certain pathologies appear to do better in group treatment than individual – these include violence, incest, paedophilia, deception and fraud. Other patients may be more suitable for individual therapy. We also offer a mentalisation-based treatment (MBT) service for men with a diagnosis of antisocial personality disorder who want to address their aggression and violence.
Our child psychotherapy team provide individual psychotherapy for children and adolescents, as well as working the parents, carers or extended family members. The team also offer consultation, advice and risk assessments to the professional network, such as social services, involved with the patient.
The Portman’s clinical staff consists of qualified psychoanalysts or psychoanalytic psychotherapists (child or adult). All clinicians have a core professional training in psychiatry, clinical psychology, social work, probation or nursing. Senior experienced post-graduate trainees and honorary clinicians also undertake clinical work under supervision.
About the author
Jessica Yakeley is a Consultant Psychiatrist in Forensic Psychotherapy and Director of the Portman Clinic; and Director of Medical Education, Tavistock and Portman NHS Foundation Trust. She is also a Fellow of the British Psychoanalytic Society and Editor of the journal Psychoanalytic Psychotherapy. She is currently leading the national development and implementation of new services for a multi-site randomised-controlled trial of mentalisation-based treatment for antisocial personality disorder, as part of the UK Government’s National Personality Disorder Offender Pathways Strategy.
StopSo, looking at the issues raised by working with both sex offenders and survivors. Views expressed are those of the author not UKCP.