Why would a woman want to work in a dangerous male environment? Why work with violent offenders and put yourself at risk?

We asked Dr Stella Compton Dickinson, author of The Clinician’s Guide to Forensic Music Therapy, to find why she chose this work and how she keeps safe…


  1. What is it like to work with dangerous offenders?

 Unlike a prison, patients in secure hospitals are not serving a fixed term sentence; they are there until assessed as no longer posing a risk of harm to the general public or themselves.

Going to work in a high secure hospital is a bit like going through airport security except you collect your keys en-route. The priority is adherence to security procedures through which a safe environment is maintained.

The patients’ have a weekly treatment schedule aimed towards recovery from the effects of breakdown from serious mental illnesses, such as schizophrenia, and / or personality disorders. The regime includes offence-related psychology, skill based education, various therapies, as well as physical exercise. Patients are escorted between treatment areas by staff.

My role provided arts therapy services that gave hope to the young black and ethnic minority patients who could use rap music, as well as to the long – stay patients who had failed in other treatments. However, I had to prove that what we did was evidence-based or otherwise my department would be axed.

Mentally ill incarcerated adults, despite having committed violent offences are themselves vulnerable to abuse. They are not the subjects of experiments such as those committed by the Nazi regime. They have restricted choice and may experience enormous shame in having killed or hurt others. But positive feelings can occur when they participate in ethically approved research, for which there is a rigorous procedure of informed consent which gives them choice.


  1. Why would I want to work in a male environment?

In my first career I was a successful session musician. I was used to surviving in a predominantly male work culture. During the eighties this was fiercely competitive, in those days of fighting for women’s rights, you had to have extremely finely honed skills to prove you were as good as the guys.

When I was appointed as Head of Arts Therapies in 2001 the hospital culture of custody, had moved to a culture of care and during the late 1990s promoted a culture of evidence–based treatment. I had survived a life threatening illness during my childbearing years. This job gave me purpose and passion to try to make others better, as well as a second family since I supervised and mentored my young team.

One evening after work I was walking along a riverbank past a fast flowing weir. Some men in wet suits appeared with kayaks, keyed up with adrenaline they said enthusiastically ‘Wow that river sucks you in and then spits you out’.  I responded – ‘it sounds like my workplace!’

The levels of need in a locked hospital are massive as it pulls you in to the caring role for men and women who often, until hospitalisation, had been abused and never cared for in a balanced kind or compassionate way. Instead, resentment and deprivation and feelings of hatred and anger have festered leading to an offence.

Female staff were valued in ensuring more balance between genders and a different vibe, which could dilute the instinctual pecking order prevalent in male offenders.


  1. How did this fulfil my purpsoe regardless of the risks?

It was initially exciting to be given a suite of large but light rooms in which to build up a brand new department; to have a budget by which to order the resources through which patients could discover new ways of expressing themselves creatively. Then from 2007 to train as a clinical researcher by which I developed the evidence–base for a model of music therapy which had to be ‘context–specific’ to meet the needs of forensic psychiatric patients.

At Guys and St Thomas’ medical school, Kings College, London, our Professor in dynamic psychotherapy taught us that there is always an autobiographical reason behind what each psychotherapy pioneer has discovered. I had suffered the effect of a depression, physical injury trauma and the associated numbing-out effect on the brain. And I had recovered. I wanted others to do so.

The model and the work are not an easy recreational option. The challenge over fifteen years of my working life involved designing a new music therapy model for offenders, which had to have a sound theoretical underpinning, be piloted and clinically tested by implementing a randomised controlled trial in this very restrictive setting; it had to have sustainable psychological change which when included in the overall multi disciplinary treatment programme goal could reduce the risk of re-offending. This could be further measured by whether inclusion of Group Cognitive Analytic Music Therapy (G-CAMT) reduced the length of stay, thereby reducing the cost to the taxpayer. (The average length of stay is six years; I have however treated patients who had been incarcerated for up to thirty years.)

I wanted to make sure the next generation of music therapists did not make the same mistakes that I had made, hence my book The Clinician’s Guide to Forensic Music Therapy.



Dr Stella Compton Dickinson is author of ‘The Clinicians Guide to Forensic Music Therapy’. She is a London-based Health and Care Profession council registered music therapist, accredited supervisor, professional oboist and lecturer, UK Council for Psychotherapy registered Cognitive Analytic Therapist and Supervisor. Dr Compton Dickinson has her own private practice and twenty years’ experience in the National Health Service as a Clinician, Head of Arts Therapies and Clinical Research Lead her research was awarded the 2016 Ruskin Medal for the most impactful doctoral research. http://www.stellacompton.co.uk





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