The Chromis Experience

Participants

We collected the information for this study as part of a broader multiple case study project. This broader study involved five individual case studies of male prisoners: two individuals who completed Chromis and progressed into the community and three who completed Chromis and had moved out of a high secure prison, but remained in custody. We targeted these individuals to offer breadth of information regarding changes observed beyond the treatment environment. As part of this case study project, four of these men agreed to take part in the interview which formed this study. One individual who had completed and progressed to the community had recently experienced a difficult period and did not wish to engage in the interview. All four classed themselves as White British and all had high levels of traits related to psychopathy, as measured by the PCL-R (Hare, 2003). See Table 1 for details of the participants, identified here by pseudonyms.

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Table 1.

Participant Characteristics.

				PCL-R score
Participant	Age	Sentence	Personality disorder diagnosis	Total (Factor 1/Factor 2)	Time on treatment unit	Time since leaving treatment site
Tom	26	Life	Antisocial, borderline	30 (11/14.9)	8 years 8 months	1 year
Ben	32	Determinate	Paranoid, antisocial, probable schizotypal	28 (10/18)	4 years 6 months	3 years 3 months
Daryl	33	Life	Paranoid, schizoid, antisocial, borderline	27.1 (8/15.6)	5 years 9 months	2 years
Paul	34	Life	Paranoid, narcissistic, antisocial, borderline, probable histrionic	37.9 (15/16.7)	7 years	1 year 5 months

Note. PCL-R = Psychopathy Checklist–Revised.

Data Collection

We developed a broad interview schedule to elicit men’s experience of participating in Chromis. Interviews generally explored their experience of Chromis, what they liked and did not like about the experience and what the impact of taking part had been for them. In keeping with the idiographic approach, interviews were not tightly structured, but rather were responsive to what each individual wanted to discuss. Each participant took part in one interview. Three interviews were conducted with the first two researchers and one was with the first author only. These lasted between 1 and 1½ hr and were conducted in their current establishments or probation office. Interviews were recorded on a Dictaphone and then transcribed verbatim by the principal researcher.

Design and Data Analysis

The study was designed and analysed using interpretative phenomenological analysis (IPA; Smith, Flowers, & Larkin, 2010). We considered IPA the most appropriate methodology as this study was not trying to create a theory but sought to understand participants’ individual experiences and meaning making (Eatough & Smith, 2006; Willig, 2009).

A small number of purposefully sampled and intensely analysed cases is typical for IPA methodology (Smith & Eatough, 2007). In a review, Brocki and Wearden (2010) found IPA studies had between 1 and 30 participants but noted that the study with 30 participants focused on only one interview. A detailed analysis of individual transcripts takes a considerable amount of time and the aim is to understand people’s experiences in detail rather than making generalised claims. That said, the inductive nature of IPA means that findings can be considered in the light of existing theories and literature (Brocki & Wearden, 2010). Understanding participants’ experiences through IPA gives us an opportunity to try and understand how and why processes such as change occur, therefore offering a valuable supplement to other more quantitative methods.

We treated each participant’s interview as one data set. The stages we used throughout the analysis were as follows: Transcripts were read and reread with notes made about important content and language, and themes were then identified within the transcript. Two of the authors completed the analysis of each transcript individually and then came together to discuss their findings and produce superordinate themes for each participant and then across cases. One of the interviews was also analysed by a third researcher not connected to the project in any way. Even though this was only possible for one transcript, this provided an additional external perspective which helped the researchers further question their perspectives on the data as a whole, which were based on some knowledge of Chromis and the study.

The aim of having multiple analysts was not to provide an objective truth but to try and ensure a rigorous analysis (Yardley, 2000). This included trying to limit the impact of any one researcher’s own experiences and assumptions on the understanding of participants’ experiences. These individual views and assumptions formed part of the discussions when analysts came together. We reviewed relevant literature, considered in the discussion of this manuscript, after the analysis for this study was complete.

The Researchers

The IPA approach states that an understanding of an individual’s experience is only accessible via the researcher’s interpretation of the person’s account, an interpretation shaped by the researcher’s own experience and knowledge (Brocki & Wearden, 2010; Willig, 2009). In this respect, it is helpful to know the characteristics of the researchers as well as the subjects. The first and second authors were responsible for conducting interviews and the primary analysis of data. The principal author is a White British woman with 10 years postqualification experience in forensic psychology and was 35 years old at the time of interview. This author currently works for NOMS. Part of her role includes the evaluation of Chromis; however, she was not involved in the programmes development or clinical delivery. The second author is a White British woman with 6 years experience in a forensic setting who was 29 years old at the time of interview. This author works as a trainee psychologist on the unit where Chromis runs, but she is not actually involved in its delivery. One interview was also reviewed by a third independent researcher who was not involved in this study in any other way. She was a 31-year-old British Indian woman with 4 years experience of accredited offending behaviour programmes. She also works as a trainee psychologist within NOMS and has no connection to Chromis or Westgate.

Ethical approval for this study was granted by the NOMS and the University of Birmingham Science, Technology, Engineering and Maths Ethics Committee.

Theme 1: “It’s Me and What I Want That Matters”

This theme was about how the individuals themselves influenced their own treatment. A very strong message from all individuals was that whether or not they engaged in treatment was under their control. Although other factors were identified as impacting on their motivation and engagement (see Make or break external influences), it was clear that the most significant influence was their own desires. This was captured well by Ben who was asked how he managed to persist at Chromis considering how difficult he reportedly found it:

Persistence. I had to want to change. I really really wanted to learn to manage myself.

Ben seemed to believe that making himself keep going on a day-to-day basis in treatment would help him achieve his longer term goal of feeling in control. Repeating “really” seems to stress the extent to which he wanted this, along with the view that he had to want it badly to be able to make himself keep going. It may be significant that Ben was the only participant serving a determinate sentence and so for whom release and the need to “manage” in the community was a more concrete prospect while he was in treatment. He was actually in the community when we met. All participants described having a very strong intrinsic motivation to complete treatment. However, within this, engagement and levels of motivation varied across time, with the timing of treatment cited as important, as explained by Daryl:

But because you got me here, at a time, yeah, where I was just sick of my life at the time, you know, being in and out of blocks [segregation units], being moved about everywhere, being quite a few years over my tariff at the time and realising I weren’t going anywhere and I was getting older, and I think they, sort of like, just got me when I was on the verge of, sort of like, saying “look, I’ve had enough. Time to knuckle down and try to get on with [it].”

Daryl, like others, seemed to suggest he had reached a point where he had had enough of what he was doing. With a sense that time was passing for him without any progress, he had to finally “get on with it,” suggesting that treatment, or maybe changing, was something that he knew he was going to have to do at some point. All men described participation as their choice and that their determination enabled them to complete treatment. However, they also identified aspects of themselves that made engagement difficult for them. These aspects seemed to largely relate to feeling a need to protect themselves and prevent others from seeing any weakness. Paul summed this up particularly well:

I just realised that I was cagey, I was very untrusting you know. I didn’t really trust anyone around me. That didn’t help going into treatment sessions because you were, you were quite guarded, you were cautious about what you said, about how you said it, how people perceive what you said, and how that might [impact] on your final reviews and stuff like that.

Here Paul seemed to have particularly good insight into himself and how he impacted on his treatment or, maybe more importantly for him, how he impacted on his reviews and therefore sentence progression. His caginess may relate to a tendency toward positive impression management often associated with individuals with high levels of Factor 1 psychopathy traits and narcissistic personality disorder, although he expresses an anxiety often reflected by offenders. Completing treatment was seen as challenging but worth it and these things seemed related. Both Tom and Ben reported that their perseverance was due to their desire and attempt to change. These individuals reported that the challenge was around atypical feelings associated with that change, as described by Ben:

Ben is describing thoughts and feelings that may well resonate with anyone who has tried something new; the idea that stepping away from the familiar makes you feel vulnerable and exposed. For Paul and Daryl, the challenge reflected their desire to complete treatment as a means to an end, to progress with their sentence and get released. This was something which they felt they had achieved and was summed up well by Daryl:

Daryl seems to be describing a very different thought process to Ben, but one that again sounds familiar to those who have faced a task they really did not want to do but they knew they have to complete. Daryl, who in the group had a lower level of Factor 1 psychopathy traits, was quite straight talking about initially not placing any value on treatment itself. He saw it solely as something he had to get through to get released. Regardless of their main motivation for completing treatment, the process of changing and gaining new skills was described as difficult by all. Individuals particularly mentioned feeling frustrated when they thought they had handled something differently, in a better way than they would have previously, and this was either not recognised or received criticism.

Theme 2: Reaping the Rewards

This theme represented what participants thought they needed to address in treatment and what they actually achieved by completing Chromis. Despite some individuals expressing their goal as being to complete treatment rather than change aspects of themselves, they all described changes they had made as a result of completing treatment and gains they had achieved from this. The process of change was generally seen as ongoing in that they talked about continuing to practice skills in their new environments. Overall there was a sense that individuals felt they had a choice in how they acted now, which was clearly something new for them.

All participants thought that treatment targeted the areas that they needed to address, with anger or aggression and tolerating a slower pace being specifically mentioned by three individuals. They all talked explicitly about gaining benefits as a result of completing treatment and these seemed to largely relate to managing their Factor 2 psychopathy traits. All participants cited a new awareness of the longer term benefits gained by the end result, such as progressing with their sentence and building a life on release that they had dreamed of while in prison. Participants all described what they believed had helped them achieve these gains which specifically were gaining particular cognitive skills, becoming more stable and less volatile, and developing better relationships with staff. These factors all clearly overlapped. For example, for Tom taking a moment to think about consequences for himself was helping him to be less volatile in prison:

Now, first thought, someone hits me, why do I need to hit him back? He’s in trouble not me. If I hit him back we’re fighting and that’s it. It’s over isn’t it? I’m nicked. Know what I mean? So, walk away.

Whereas Daryl describes an interaction between forming better relationships with staff and being more stable in prison:

I’ve been here 2 years now and I’ve been placed on report twice; twice for drugs. Once was when I first came here. That was more to do with medication rather than actual drugs. And one a couple of weeks ago. And so I’ve not been being aggressive toward any staff. I actually get on with quite a lot of staff on here. I don’t think there’s any staff I don’t get on with. Erm, I’m not always up and down the blocks, I’m settled in.

In terms of gaining specific cognitive skills from treatment, individuals commented on thinking about consequences for themselves, understanding and tolerating people having different views (perspective taking) and identifying their problems, and considering different options to solving issues (problem solving). They also highlighted communicating as a specific gain—particularly communicating in conflict situations, and also negotiating more generally. The idea of slowing down and thinking about things a bit more seemed key to all of the areas that individuals raised.

The two individuals who seemed less overtly positive about treatment and its impact still acknowledged a development in their relationships with staff. Paul was one of these individuals:

Despite having seen Chromis and his learning as something that was in the past and he will “take it to the next life or whatever,” Paul still makes a link between being in treatment and his relationship with staff changing. Given his narcissistic characteristics, which were evident in the interview, it is of note that he did not take the full credit for this himself but acknowledged that treatment helped him. While individuals acknowledged characteristics of staff that influenced any shift in their relationships with them (see Make or break external influences), they also identified that the relationship had changed because of them deciding to “give staff a chance” or because of how they had changed their behaviour, as described by Tom:

Obviously it [staff behaviour] changed because I was different. Because in my opinion, some staff have said they were a bit wary to challenge me sometimes because of the way I reacted, and that’s probably why they didn’t come and challenge me sometimes. Probably why they just went and wrote it down. But after . . . , near the end, if anything had happened or anything was done wrong they’d come and tell me.

Tom had criticised staff who had written things about him without telling him, feeling that he needed to be told about things he had done wrong to be able to learn. However, he did seem to accept why people may have been reluctant to do this during his early days on Chromis. He was preventing this from happening, and when he changed, others around him changed how they treated him; he got what he wanted.

Theme 3: “It’s Treatment Itself That Makes Things Hard”

This theme represented individuals’ views on the structure and content of the treatment programme. Participants’ narratives were made up of issues around the length of treatment, repetition of content, and the paperwork attached to treatment. The length of time it takes to complete treatment and the repetition within the programme were both areas that Tom and Ben, the two individuals who wanted to participate to instigate change within themselves, spoke about struggling with. This finding is in contrast to what might be expected—that the other two participants, who wanted to undergo Chromis more to move through the prison system, would be the ones more frustrated by the length of treatment. Interestingly, Ben, who was living in the community, was now able to recognise that while he found this frustrating at the time, it was necessary to get everything “drilled into him” because life in the community was difficult.

Chromis paperwork also seemed to be a particular issue. One person spoke about the benefits of having paperwork to refer back to after completing treatment. However, others focused more on difficulties with paperwork, or the lack of value in having completed this, particularly the out of session work. Some individuals also commented on not liking reading and writing generally, as described by Daryl:

Although Daryl was keen to point out that he was capable of completing written work, he was quite forthright in his views that this was a barrier to engaging for him. From other things he had shared in interview, his dislike of written work may have been linked to reminiscences about early experiences of this at school.

Theme 4: Make or Break External Influences

This theme captured three key aspects that were identified by all participants as having a significant impact on their experience of Chromis. Staff, other prisoners, and the environment were all identified as being able to influence engagement in both positive and negative ways.

All participants reported that staff, particularly uniform staff, seemed significant. Their significance related to the inhibitive impact of having people in uniform in treatment sessions but a positive impact on relationships with uniform staff as a result of their involvement and interactions around the unit. It was suggested that problems with staff around the unit were taken into the treatment room, and the presence of a uniform staff member in treatment could create an atmosphere and acted as a barrier to engaging in sessions.

A number of staff characteristics were highlighted as influential. Staff being perceived to have time for you, offering support, being consistent and straight, being genuine and motivated, and communicating “well” with participants all appeared to have a positive impact on individuals and their treatment. However, the opposite characteristics, such as not seeming to provide support or being inconsistent in what they said and did, were noted as having a negative impact. Tom particularly struggled with experiencing inconsistency between what staff said and did:

Just like, you’ll be sat in a room, like this, doing a course, Creative Thinking or whatever, and they’ll teach you one thing in here and out there they’ll go and do the total opposite to what they just taught you in that room, to somebody else. Know what I mean? That is, being aggressive towards them or doing whatever. And I’m like, how can you teach me in here to do this and then out there you do exactly the opposite?

Given that individuals with high levels of psychopathic traits are sometimes accused of being able to “talk the talk but not walk the walk,” it seems particularly striking that Tom, like others in the group, struggled when they saw this in others. Seeing staff do things that are in contrast to how they tell participants to behave seems to undermine the credibility of the individual and Chromis material. This difference may also contribute to Tom’s view that they are being “taught” rather than the collaborative approach that Chromis aims to achieve. Tom’s diagnosis of borderline personality disorder, rather than his high levels of psychopathy, seemed particularly relevant when viewing this statement in the context of the whole interview. Although he certainly was not alone in this view, Tom was the one who talked most openly about his significant close relationships with staff making it not surprising that he was the one who voiced struggling with any inconsistency in the clearest terms.

Individuals generally felt that other participants made treatment harder, with everyone expressing a view that they preferred individual to group sessions. Other prisoners were seen as a barrier, either because of having to listen to them speak or due to the nature of their offence. The difficulty of having to listen to others related to the content of what they said and to the simple fact that it took the focus away from them, as might be anticipated for individuals with high levels of psychopathic traits. This was another barrier that Daryl summed up well:

That’s why yeah, if I’m in a group and they’re doing some work with me yeah, and then you have to sit there for a few days listening to other people’s problems and going and helping them through theirs, when you’re not doing anything, [it] used to do my head right in.

Daryl clearly did not see any value in working with others, seeing this as a period where he was doing nothing, or at least that there was nothing in it for him. While Daryl was generally quick to identify things he did not like about treatment, he was not the only one who struggled to tolerate others. Working with sex offenders was identified as a significant struggle. All participants had difficulties tolerating working with sex offenders, except for one individual whose offence history included a sexual offence.

Although the dominant theme was of an inhibitive effect of other participants, there was still an acknowledgement that working with others had benefits by offering an opportunity for support and development. The issue of support was expressed from both the perspective of liking being able to give support and appreciating receiving support from someone they trusted.

Participants also highlighted the supporting environment, as being significant to the success of Chromis. Most comments related to the helpful aspects of the Westgate unit for engaging in and completing Chromis. Being able to settle in and feel comfortable before you focus on treatment and being able to express feelings and practice skills outside of the treatment room were aspects that were seen to help them benefit from and complete treatment. Possible environmental barriers identified were the environment not being structured around the treatment, not everyone being involved, and not being able to link treatment to your current situation.

The Findings

This study examined four male offenders’ experiences of participating in the Chromis programme. All participants shared a general perception that taking part in Chromis was challenging but worthwhile, and four themes emerged as important to their lived experience. Despite difficulties, all men completed the programme, which they felt was largely due to their own determination and it being “the right time” for them. The importance of individuals’ own motivation for engaging in and completing treatment was also highlighted as being significant for male forensic inpatients (Mason & Alder, 2012). This is in addition to the fact that individuals can have different reasons for engaging in treatment (Stewart, Oldfield, & Braham, 2012). Whatever their goal for participating, individuals in this study were all able to describe changes they had made, which typically related to being more settled in their new environment. This development may be unsurprising given they are in prison or supervised in the community and are therefore likely to want to present themselves favourably. The individuals who successfully completed Chromis add to the literature that offenders with high levels of psychopathic traits are capable of engaging in and benefiting from treatment (D’Silva et al., 2004; Lösel, 1998; Salekin, 2002). This study provides insight into how and why this process can occur. Reviewing individuals’ experiences in detail supports the heterogeneous nature of those with high levels of psychopathic traits (Tew et al., 2013) and suggests that these individuals can have insight into aspects of themselves and their experiences.

These experiences add support to the approach to treatment suggested in the literature and the principles that underpin Chromis, suggesting that these approaches and principles do translate into practice, at least for some participants. The areas participants described changing as a result of their treatment experience largely related to PCL-R Factor 2 traits of psychopathy (Hare, 2003), namely, impulsivity, behavioural control, and a proneness to boredom. This finding supports the literature which suggests that the behavioural aspects of psychopathy are more amenable to change than the interpersonal and affective aspects of the disorder (Thornton & Blud, 2007). These changes highlight participants’ application of skills from treatment to their own lives. Individuals described feeling like they had increased control and choices post treatment, suggesting that this core principle of Chromis had been particularly effective. The nature of the gains made in treatment by participants is similar to those in other studies (Willmot & McMurran, 2013). In addition to these gains, where individuals were able to identify aspects of themselves they were not happy with, and aspects of Chromis that were relevant to their own goals, they were able to engage and benefit as a result. However, individuals who were less explicit about this process did still seem to benefit from their experience of Chromis. This finding highlights the importance of spending time establishing participants’ own goals at the outset. Considering comments such as Tom’s, which described what helped him to walk away from a fight, it may be that self-reflection about the consequences of their actions could be an effective step in achieving behaviour change.

Although participants identified themselves as the main driving force behind what they had achieved, they also identified that staff, other prisoners, and the treatment environment were all influential factors in the success of treatment. All men described difficulties in developing relationships with staff, but all describe more settled relationships over time both on Westgate and on transferring to a new environment, suggesting that while their interpersonal traits may not change, their experiences of relationships can. The significant positive role that consistent and supportive staff can play in engaging individuals has also been highlighted with inpatient groups (Mason & Alder, 2012; Stewart et al., 2012; Willmot & McMurran, 2013). The environment for treatment also seemed to be important to Chromis participants. They valued having a supportive environment where they felt comfortable, could practice skills and express their feelings, and still be worked with. Given that individuals with high levels of psychopathy have been found to be less likely to generalise and maintain skills learnt in treatment than those with lower levels of these traits (Blud, Thornton, & Ramsey-Heimmermann, 2003), it is encouraging that individuals highlighted the value of this. This finding again supports other studies looking at patients’ experiences of treatment (Mason & Alder, 2012; Willmot & McMurran, 2013). The issue of some Chromis participants disliking the length and repetitive nature of treatment is a view shared with patients involved in other interventions (Stewart et al., 2012).

Working with others was reported to be influential by all participants in this study. The benefits of working in groups and getting support from fellow participants have been explicitly realised by patients in high secure hospital treatment (Mason & Alder, 2012; Stewart et al., 2012; Willmot & McMurran, 2013) but was not strongly supported by Chromis participants. The focus in this study was on the difficulties and inhibitive effects of group work. This difference may be related to the particularly high levels of psychopathic traits of the Chromis population, relative to participants in other studies.

The finding that the timing of treatment and the intrinsic motivation for change was significant for all participants is relevant to stages of change theory (Prochaska & DiClemente, 1982) and appropriately targeting treatment to individuals’ goals. While clearly an issue for all treatments, Sheldon and Tennant (2011) suggested that assessing individuals’ readiness to change and their goals is particularly important when working with this population. They suggested that therapeutic alliance can help address an individual’s low readiness to change.

The two individuals who explicitly described wanting to change also described developing more positive relationships with staff and feeling like they got more support from staff compared with the men whose goal was sentence progression. This adds support to the view that, at least from the participant’s perspective, those with psychopathic traits are able to form therapeutic alliances with staff (Ross, Polaschek, & Ward, 2008). Taft, Murphy, Musser, and Remington (2004) found that motivational readiness to change mediated the association between psychopathic characteristics and relationships with treatment staff. Whether motivation is needed to help develop a therapeutic alliance, or whether developing a therapeutic alliance helps to build motivation is debatable, however, it does seem intuitive that these factors are interrelated.

Potential Clinical Implications

Understanding the experiences of Chromis participants in the context of literature relating to the treatment of those with high levels of psychopathic traits and investigations into patients’ experiences of treatment has provided useful information that can inform treatment design and delivery. The many areas of similarity between Chromis participants and those in other studies increase the confidence that can be placed in using these findings to inform practice. This study suggests that there is value in investing in treatment for those with high levels of psychopathic traits and that the principles and methods used in Chromis can be beneficial for individuals. It appears that participants do perceive changes in areas related to their Factor 2 traits and value support in generalising skills beyond treatment. The timing of treatment was important, in that it worked well if participants had identified something they wanted to change and saw treatment as being relevant to this aim. Being able to see the consequences for themselves of their choices also seemed particularly helpful. As with other populations, understanding what an individual’s motivation is for taking part in treatment and where they are in terms of wanting to change can help inform targeting and assessing progress for individuals with high levels of psychopathy. This finding could be seen to support the work of Yochelson and Samenow (1977). These authors highlight the need to understand individuals’ thinking processes to distinguish between offending and nonoffending individuals with high levels of psychopathic traits, as well as understand offenders more generally before trying to help them change.

In addition to this, it was found that there are advantages to having uniform staff involved in treatment delivery. Although their involvement may prove challenging for participants initially, there appears to be longer term benefits in terms of how they see their relationships with custodial staff, which can impact on compliance to regimes and progress with sentences. This is a new and potentially very significant finding that could be followed up further to better understand the issue. This could be done both through research with other groups of participants, such as noncompleters, and through gathering more information about the longer term impact of any changes in relationships between participants and uniform staff. Consistency was suggested to be helpful in Chromis completion. Consistency of staff across treatment and a consistent approach from staff across the unit in terms of learning and practicing skills were cited as important by the participants. As these individuals completed the treatment, the delivery model has been adjusted so that where possible the same staff deliver all three cognitive skills components, which may help provide a sense of consistency for participants. Chromis is currently delivered from a self contained unit where all staff are selected and trained to work with this group. When Chromis rolls out to other locations, it will be important to consider how to embed the programme and its approach into the regime. The selection and appropriate training of staff is likely to be influential in this (Atkinson & Tew, 2012). This process would need to capture the characteristics required to support positive engagement of participants, including an understanding of why it is important for staff to model the skills and behaviours highlighted in treatment. Staff being willing to explain their behaviour to participants helps to provide clarity and an opportunity to support learning.

Considering both relationships with staff and motivation to change, this study adds to the idea that efforts to help participants increase either of these may have benefits for both and be worthwhile for enhancing treatment success. The unit has recently started to pilot the Motivation and Engagement phase of Chromis being part of their assessment process for admission, one aim being to help develop these areas. However, Polaschek and Cross (2010) found that it was the development of an alliance with staff over the course of treatment, rather than initial levels of therapeutic alliance or motivation, that related to change in treatment for high risk, psychopathic violent prisoners, indicating that these areas need to be considered throughout the Chromis programme.

In contrast to the wider literature, it was apparent that Chromis participants preferred individual work to group work. However, they appeared to gain benefits from learning to manage relationships with others that may relate to taking part in group work. It may be that making group work a more explicit part of the learning for participants would help individuals see some relevance in this for themselves. Making the benefits of practicing and consolidating skills more explicit might also help individuals understand the length of treatment. A lthough Chromis is designed to be particularly responsive to individuals’ learning styles (Tew & Atkinson, 2013), this study suggests more could be done in this area, particularly in relation to written work.

Limitations and Future Work

The results of this study aim to understand men’s experiences for experience sake and are not automatically generalisable to the wider population of men undertaking Chromis. This should not be viewed as a limitation but rather an opportunity to understand participants’ experiences in detail, in the light of current literature, which allows insight into the complex processes that may be obscured within larger scale quantitative methodologies. This process provides important information which can help inform future implementation and management of the Chromis programme. Further research considering the experiences of other Chromis participants, for example, noncompleters, would also be informative. Indeed, these were retrospective accounts of the experience of treatment from individuals who had completed Chromis and left the unit. It may be that individuals’ current circumstances impact on their view of treatment, such as how content they are with their life at the time of interview.

Using IPA to access the experiences of individuals with high levels of psychopathic traits is challenging. These challenges include issues regarding the relating style of the participants, the experiences of the researchers, and the situation within which interviews were conducted. These have been reflected on more extensively in a separate paper (Tew & Bennett, 2014). The particular personality traits of the individuals will impact on their presentation in interview, and the experience of the interviewers will impact on the interviewer’s perceptions. As a group, those with high levels of psychopathic traits have been found to struggle with their insight into themselves and their ability to reflect and learn from experience (Cleckley, 1988). This study may have been challenging for some participants but may not have offered the same challenges that being asked to reflect objectively on oneself might. It did not necessarily require participants to have insight into themselves, but rather insight into something they have experienced: the Chromis programme. This study did not try to ascertain the level of truth in what participants told the interviewers, for example, regarding their levels of attendance or changes they had made. Although individuals’ accounts of these issues may or may not correspond to information from other sources, focusing on their perceptions has provided important information to help inform future delivery and design. IPA allows for access to an individual’s experience via the interpretations of the researcher, meaning that there was scope to consider individuals characteristics within the analysis process. Both researchers in this project had clinical experience of assessing and working with men with high levels of psychopathic traits, and this was clearly evident in the discussion during the analysis process. Gadamer (1975) suggested that as people make sense of others through their own prejudices, it is not possible to bracket off our own ideas to be truly open to the meaning of others. The balance for the researchers in listening to their own ideas, but not letting them take over, was particularly challenging with this population. Individuals with high levels of psychopathic traits have been found to bring about feelings such as confusion and disbelief in interviewers (Nyholm & Häkkänen-Nyholm, 2012), feelings that need to be acknowledged, understood, and managed. While the researchers were clearly aware that individuals had been accepted for Chromis, they did not review the particular clinical information for each individual. They consider that their general knowledge of psychopathy helped inform their work but not knowing the details for each person helped avoid specific preconceptions about them and ensure the research focused on the interview and their experiences.