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Dr Gerard Drennan
Crisis, disaster and trauma, Legal, criminological and forensic, Violence and trauma

‘If there is trauma, there will have been harm. We need to attend to it…’

Editor Jon Sutton meets Dr Gerard Drennan to hear about his work in restorative justice, in forensic and mental health settings.

10 October 2022

How did you first get interested in restorative justice?

I became aware of it through the publicity that the Truth and Reconciliation Commission had in South Africa. I was working as a clinical psychologist in a mental health hospital in Cape Town at the time, and was doing a PhD on the role of interpreters in mental health settings in psychiatric hospitals. Our whole society was aware of the Commission, it was being talked about all the time. In the media, and people like Desmond Tutu talking about approaches to conflict and how to produce the result that's needed – in terms of nation building, community repair, even the social justice of it.

Also, working in therapeutic communities with the idea of being accountable to a community, making repair when something happens that doesn't just affect one person. That's fundamental to the ethos of restorative justice – it's not just about what happens between two people, there's this ripple effect of harm where mothers, daughters, sons, uncles are affected by what people do as well. On both sides, actually, both the harmer and the harmed, their social circles are impacted. Recognising that it's also a systemic intervention, because of the impact on community, captured my imagination as well.

At that time was it quite unusual to apply those approaches in a mental health context, rather than forensic and related to offending?

At the time, I wasn't working in forensics settings… it was more our patients talking about the harm that had been done to them. When I came to the UK and worked in forensic settings, back in the 2000s, we were working on how to introduce recovery orientated practice into forensic mental health settings. We quickly became aware that the recovery journey for a forensic patient is often more complicated than for a mainstream mental health patient.

The structure of a restorative justice conference is fundamentally a narrative structure. But it's a narrative that might take quite a long time to develop.

There are two aspects to their difficulty. One is the mental health issue that they need to recover from. But there is also the impact of the offence that they've committed. They need to be on their recovery journey in relation to their reoffending, and sometimes that's more difficult. They might be more ashamed of their offence than they are of their illness. They might be more stigmatised as a result of the offence than the illness. We would have patients in forensic settings who, for example, aren't able to return to where they grew up because of the nature of their offence. If they 'only' had a mental illness, they wouldn't be excluded from their community in that way.

So we were trying to think about how to attend directly to 'offender recovery' – that's a clumsy phrase which has never really stuck, instead we tend to talk of 'secure recovery', with more of an emphasis on safety. Recovery for forensic patients has to include safety, not just recovery of a positive sense of self and sense of purpose and meaning in life.

I tried to start a conversation within the forensic network around the place of restorative justice interventions in this offender recovery journey. I got support from our senior leadership team in Sussex Partnership Trust, to train a cohort of staff as Restorative Justice Conference facilitators. For the first time, we properly understood what it meant to apply restorative justice in individual interventions.

Conference facilitators suggests a physical place and an actual time for people to tell their stories? What you're talking about here seems to be a narrative progression of offender recovery towards ownership of the behaviour.

It's all about story. The structure of a restorative justice conference is fundamentally a narrative structure. But it's a narrative that might take quite a long time to develop. The actual meeting is between the person who harmed and the person who was harmed, but also including their supporters… for both sides to be humanised in some way they both need to be represented by people who care for them. So sometimes there's quite a large cast of people involved, with layers of representation, and in very serious offences that can take up to a year to prepare for.

There's a rule of thumb in restorative justice – you don't steal the conflict. You aren't responsible for making it better. You have to enable the dialogue between the two people involved and not try and get in the way too much.

Sometimes 90 per cent of the work is done in the preparation. The person who harmed has to be assessed for risk as to whether they're going to re-traumatise the victim; the victim has to be assessed for their vulnerability, but also whether they are using the meeting for retribution. Invariably, there is an advanced agreement, that the person who caused the harm is going to offer an apology, and that the person who is was harmed is going to accept that apology, and perhaps accept acts of restitution. They may say, 'I will accept your apology, but I can't forgive you'. But that is a basis on which to proceed, with loads of preparations for their safety. There's a whole lot of psychotherapeutic work that happens in the preparation phase… that could go on for months.

It almost sounds like both sides need to be so far down that road, by the time they get to the conference, that there's not much left to be said beyond kind of dotting the i's and crossing the t's… or are there significant final steps that tend to happen in person?

There are so many ways in which that can unfold in the meeting. In the UK, we tend to use what's called script-based conferencing. There's a structure that is guided by a set of questions. Each of the parties get asked those same questions, for example the harmer gets asked 'what do you think is the worst aspect of what you did?', and then the victim of their harm gets asked 'what has been the worst part for you?' The unusual structure of it as a systemic intervention, is that the person who caused the harm, the offender, they speak first. They give an account of what they think was the impact, and only then do they hear what the actual impact has been.

But that's when the conference goes according to plan. But actually what you're saying about that preparation, you're absolutely right. There are some conferences that begin with an embrace. It's already been so prepared for that the moment of reconciliation happens right at the start.

You mentioned that the psychoanalytic side…  you are a psychoanalytic psychotherapist, can you give an example of how that approach manifests itself in the process?

It's not explicitly analytic. When you are trying to be a conference facilitator, as a psychologist or psychotherapist, one of the things you have to do is to try not to be too much of the therapist. There's a rule of thumb in restorative justice – you don't steal the conflict. You aren't responsible for making it better. You have to enable the dialogue between the two people involved and not try and get in the way too much.

The analytic perspective is often an assessment of what people's motivations might be, and their readiness. Sometimes, the person who caused the harm is actually using a restorative intervention in order to short circuit their own process. 'If I can just say sorry, it's all going to be over. I can just put it to rest and I don't need to think about it again.' Analytic insights around that can be helpful, but a range of therapeutic understanding applies too, not just analytic.

One of the critiques of restorative justice within psychology is that it doesn't have a theory of rehabilitation.

There is also the important thing in all therapies about 'working through'. The conference is considered to be a watershed moment where things are intended to move forward, to introduce change; but that invariably also requires you to walk the walk. That's where thinking psychotherapeutically with both the victim and the person who caused the harm – about how they then embed their learning and develop from that moment – is informed by therapeutic approaches.

One of the critiques of restorative justice within psychology is that it doesn't have a theory of rehabilitation. That process that I've just described is a bit of a black box, it hasn't really been unpacked. There are some theories about emotion, and about the ritual structure of the intervention, but it hasn't really been properly studied psychologically. So what we do in terms of applying restorative justice interventions in mental health is recognising that often the person who has caused the harm, they need quite a lot of rehabilitation preparation, to get to the point of being ready. And then they need support with embedding their learning through a skills-based acquisition process.

How far along the road do you continue? 'They've hugged, they've said sorry', or, in a mental health setting, 'they feel better'? Or beyond that, to restoring a meaningful and productive life? Is it quite an ambitious approach in that way?

Yes, it would be ambitious to think that single meeting is going to be what's required to change the world.

The best outcomes from restorative conferences are when the person who was harmed continues to support the recovery of the person who caused the harm. There are some very prominent national examples. So Peter Woolf and Will Riley had a restorative justice conference years ago, after Peter broke into Will's house. They went on to form an organisation called Why Me, that is a national service provider for restorative justice. And the first murder case in the country to use restorative justice in the country, the couple involved in that Ray and Vi Donovan, went on to form a charity and actually helped one of the people who was convicted of the killing to find a job. They recognised that they came from a disadvantaged background that contributed to what they did, and they wanted them to be able to get on with their lives constructively.

Is one of the main sentiments that you come across if you talk to people about restorative justice, 'I couldn't do that. If I was the victim of a violent attack, I couldn't go through that let alone come out at the end with forgiveness'. There was a case recently, where the guy giving his victim statement in court was very compassionate and understanding about it, and it made the national news as an apparently surprising reaction.

 Yes, it is quite uncommon for people to have the kind of bravery that they need to be able to do it. It helps if it is a family member, and they're invested in the relationship that they want to repair. But if it's a stranger, it does take bravery. And that's why one of the things that I'm trying to work on at the moment, through the Restorative Justice Council, where I am Chair of the Board of Trustees, is to apply what we've learned from forensic mental health. If our patients who have caused offences are going to be ready for a restorative process, we need to support them with their skills, and also with their over-identification with being victims themselves.

Fundamental to forensic work in general, but also to restorative justice work, is to try and understand something about what happened to you and not just go with a diagnostic labelling approach.

We've created a rehabilitation programme to enable that journey, for the narrative process to develop. And I'm hoping we'll create materials for the general public, to articulate how it would be possible and what the benefits are. Otherwise people sit with their pain and their anguish in a place where they think 'I can't even go there', if they haven't been sufficiently supported to think about how they might move on.

And that's over-identification with the victim status… when you just remain stuck in that particular incident.

Well, I don't want to presume to say that about people who have been victims, but actually our patients who cause harm, they often identify with being victims themselves. They feel that what they did was self-protection, because of their bad experience. It is a very psychoanalytic thing to say that victims themselves may be over-identified with the victim position. That may be true, but there's a risk of pathologising and patronising victims. There may be 1000 reasons why someone might say no, the restorative process is not for me.

It sounds like it takes a lot of thought and compassion on the part of all parties. And I did notice on LinkedIn, you're described as a 'thoughtful and compassionate psychologist'. Presumably a self-description?

Well, a colleague accused me of that.

'Accused' you… interesting! That goes back to what we were saying about the perception that it's unusual to be forgiving and compassionate. Even within psychology, do you think there's a slight stigma to being described as a thoughtful and compassionate psychologist?

It's more embarrassment. I think compassion is a really important quality. It draws me to forensic work. My colleagues as well, we're invariably drawn to work with some of the most disadvantaged. Perhaps those who have done unspeakable or unthinkable things… we still try to find a way to be compassionate, and to recognise something of their story about how they got to where they are. So compassion, and also, I think, a sense of social justice, that our response to people who cause harm needs to be humane, and not just driven by a wish to punish.

I've just put an article on our website by Paul Gilbert, taking a compassion-based approach to the war in Ukraine. Presumably, what you're doing aligns with other kind of major movements in the last few years in psychology. I've witnessed a move towards social justice work, and it sounds like there's elements of the Power Threat Meaning framework and in what you do too?

Absolutely. Fundamental to forensic work in general, but also to restorative justice work, is to try and understand something about what happened to you and not just go with a diagnostic labelling approach. We've really benefited from the development of compassion focused therapies and the tremendous momentum to trauma informed care. Our strapline in the restorative circle at South London and Maudsley, is 'trauma informed, harm aware'. Two sides of the same coin – if there is trauma, there will have been harm. We need to attend to it, in both respects. Especially for our patients, we can't just focus on their experience of trauma, but also on the way in which they resulted in other people being traumatised too.

Quite a systemic approach. You've talked before about the power of institutional settings to create what counts as real, and institutions creating shadowed places.

That's a quote from an anthropologist. What you were saying about the Power Threat Meaning framework, that has created another lens through which to view human experience. It's challenging the diagnostic lens as being the only way in which to create or construct reality, because that creates shadows and things that don't get looked at sufficiently. We can shed a light on this element of human experience that is actually more compassionate, potentially more helpful, not stigmatising.

One of the ways in which the restorative justice focus is shedding a light on our service is through MSc research projects where we are asking our patients about the extent to which we help them to have victim awareness. What's coming back is that we aren't that good at helping them to develop victim awareness. We talk about victims in the abstract, but we sometimes avoid the distressing conversation about the actual victim, and what might have happened to them since. What has happened in a victim's life afterwards, did they recover? We continue to imagine them as they were at the time of the offence, rather than how things have progressed. So now, we're trying to actually create a space in which we can do more to hold victims in mind.

The mental health system isn't set up to enable restorative meetings between patients and the people they harmed.

Fundamentally, it's about being fit for purpose as a service to allow victims to access restorative justice with mental health patients, because at the moment, they invariably don't. The mental health system isn't set up to enable restorative meetings between patients and the people they harmed.

Is that sort of thing that has hampered progress? Has change been slow in this area, and what could accelerate it?

We're hampered by a lack of organisational memory. Our staff also get hurt by our patients, and we will remember what the patient has done, but we won't remember the staff member who has been hurt.

And mental health staff tend not to be well informed about the restorative justice. They often have an assumption that the evidence base is poor, when in fact isn't. There isn't a great evidence base for restorative justice with mental health patients, that's true, but one of the reasons for that is that we assume that our patients can't participate – that they don't have capacity or that they're too impaired to meaningfully contribute. Sometimes even victims assume that, that the patient can't give an account because they were unwell at the time. Those assumptions are getting in the way of being able to move things forward.

There is also the ethical question – a worry that a vulnerable patient could themselves be destabilised or harmed by impactful encounter with the victim. Sometimes restorative justice is written about as being the soft option, but others have pointed out that if it is to be really impactful, then it can also be severe. A patient who is vulnerable could relapse or decompensate. Our experience in trying to do this work is that patients actually do sometimes relapse in the preparation phase.

It's not an easy process.

Not an easy process at all. So it's partly clinicians who fear that they might be doing harm to patients who are very wary of going into an area in which there isn't a good evidence base, and where there's a degree of risk.

Our profession needs to find more ways to engage with restorative thinking generally.

In forensic settings, I guess it's an area where one 'worst case scenario' – for example the Usman Khan terror attack – can set the cause of restorative justice back years.

That's absolutely right. That has happened in cases of domestic violence and sexual assault as well, when things that were called restorative justice, but weren't really, go badly. What's happened nationally is there are many policing areas that prohibit restorative justice being used in cases of domestic violence and sexual assault, because there was one high profile case.

In terms of the harm to staff, it does sound like quite draining work. Do you do find it that way? And if so, what do you do in terms of self compassion?

Being psychoanalytically trained, the requirement is to have one's own analysis. That's very protective in the work, but in some ways the pandemic has taught us how much more vigorous staff support efforts can be. We're also being helped with trauma informed care, to attend to our staff needs better. I'm also hoping to create more structures for support for restorative justice practitioners, because their levels of support can be quite variable across the country. You sometimes get lone practitioners in the service, where they're the only restorative justice practitioner and they have to deal with all of the cases, where some cases might be quite triggering for them. We need to be better at attending to the needs of facilitators. In a way, in mental health, we're quite protected because we often we hear the offender's story and what they did, and we can be compassionate towards them. But the restorative justice practitioners have to hear both sides of the story, to try and find a way to be compassionate to both sides. That can be very draining, and exhausting.

I can't help noticing that was mostly about other people. Stop being so thoughtful and compassionate, for one second! What about yourself?

Time with family, friends, enjoying hobbies, you know, having space and time for myself to do those things, that's protective. And being by the seaside.

This Leicester-based guy is very jealous. Do you have a final thought on what needs to change?

Our profession needs to find more ways to engage with restorative thinking generally. Not only restorative justice, but how we can contribute to community repair, peacebuilding, social justice generally. That conversation is already underway, but we need to develop and sustain our momentum. To meaningfully contribute towards our society as a whole, rather than just the people we help in our clinics.

And you think that can be grounded in specifically psychological theory and research evidence? Because one of the criticisms from within our own profession is 'if you want to do that, knock yourself out, but it's not psychology, it's the domain of social workers or other domains'.

It's engaging in those individual and community processes. Our skills for identifying the evidence – that old phrase, 'don't make the measurable important, but the important measurable' – we do need to be applying our empirical skills to that rather than saying 'that isn't our problem'. Our psy complex needs to be up alongside social workers and other types of organisations. We see that in the care system – psychological thinking about traumatised families and young people is profoundly helpful to social workers, who are often having to do incredibly difficult jobs without necessarily having the level of skill and training that we've been fortunate enough to get.

Similar sorts of arguments apply to thinking about the scale of intervention. Social justice can sound like it's a macro level intervention, but actually social justice is operationalised with individual people and and individual relationships at the grassroots as well.

About Dr Gerard Drennan

Dr Gerard Drennan is a Consultant Clinical Psychologist and Psychoanalytic Psychotherapist, who holds the post of Head of Psychology and Psychotherapy in the Behavioural and Developmental Psychiatric Operational Directorate of the South London and Maudsley Mental Health Foundation Trust. He is also an Honorary Lecturer at the Institute of Psychiatry, Psychology & Neuroscience at Kings College London.