Compassion focussed working in secure forensic care

2017 ◽  
Vol 3 (4) ◽  
pp. 287-293 ◽  
Author(s):  
Jon Taylor
Keyword(s):  
Personality Disorder ◽  
Emotional Regulation ◽  
Emotional Processing ◽  
Deep Understanding ◽  
Therapeutic Interventions ◽  
Offender Rehabilitation ◽  
Content Type ◽  
Forensic Care ◽  
Challenging Behaviours ◽  
Processing Mechanisms

Purpose The purpose of this paper is to describe practices associated with compassion focussed therapy (CFT) in a secure forensic setting for men with a learning disability and personality disorder. The values of this model for both therapeutic work and the organisation of residential practices in a secure setting are considered. Design/methodology/approach The paper presents a conceptual discussion of the use of CFT with an offender population. Findings The paper describes the use of CFT as a framework for working with offenders with an intellectual disability and personality disorder. The paper discusses the organisation of service practices alongside more formal therapeutic interventions. Practical implications CFT offers a unique integrated model for working with offenders. The core CFT model invites staff teams to consider the safety seeking aspects of challenging behaviours and to understand these behaviours in the context of evolved threat processing mechanisms. The focus on emotional processing that is central to the model invites services to develop deep understanding of the functions of violence and other offending behaviours and to balance work in these areas alongside the development of capacities that offer individuals methods for effective emotional regulation. Originality/value The paper provides a unique discussion point for the organisation of forensic services for this population. The consideration of the wider social context of offender rehabilitation in terms of the residential settings, and the juxtaposition of this with formal treatments is rarely considered.

Training NHS staff to work with people with trauma induced emotional regulation and interpersonal relational difficulties (TIERI)/borderline personality disorder

2020 ◽  
Vol 15 (2) ◽  
pp. 45-58
Author(s):  
Jurai Darongkamas ◽  
David Dobel-Ober ◽  
Beth Moody ◽  
Rachel Wakelin ◽  
Somia Saddique
Keyword(s):  
Mixed Methods ◽  
Personality Disorder ◽  
Emotional Regulation ◽  
Medical Model ◽  
Minor Variation ◽  
Therapeutic Alliances ◽  
Content Type ◽  
Training Package ◽  
Mixed Methods Evaluation ◽  
Relational Difficulties

Purpose Improvement is sorely needed to the National Health Service (NHS) care for people with trauma induced emotional regulation and interpersonal relational difficulties (TIERI), currently labelled as a variant of personality disorder [PD; borderline personalty disorder/emotionally unstable personality disorder (BPD/EUPD)]. This study aims to improve staff training. Design/methodology/approach A mixed-methods evaluation demonstrated the benefits of offering 495 staff three-day trainings with a clinician-designed, unique training package. Findings Statistically significant improvements were reported in both staff confidence and optimism when dealing with people with a diagnosis of PD (PWDPD) and scores on the Helping Alliance questionnaire. No statistically significant changes in social attitude resulted. Qualitative data shows negative descriptions generated by staff decreased post-training with an increase in positive and neutral descriptions. The responses generated six different themes: resources, client demand, medical model, emotional, human and positive rewards. Differing proportions were found pre and post-training. Research limitations/implications This was a clinical-world evaluation, not a formal research project. Different pairs/combinations of experienced clinicians (predominantly clinical psychologists) acted as trainers. Some minor variation occurred within the training package used and presentation. Practical implications Given the expense of staff time and resources, this evaluation shows the resultant positive changes achieved. TIERI staff about the difficulties experienced by PWDPD and how to negotiate the relational dynamic is essential. Training helps improve staff perception of the people involved, improves staff confidence and promotes better therapeutic alliances (key to providing the relational and trauma work needed). Ongoing supervision is likely needed post-training. Originality/value Positive changes resulted from a mixed-methods evaluation of three-day trainings by using a specially designed training package.

Emotion-Oriented Coping Style Predicts Self-Harm in Response to Acute Psychiatric Hospitalization

Crisis ◽  
2020 ◽  
pp. 1-7
Author(s):  
Jacqueline M. Frei ◽  
Vladimir Sazhin ◽  
Melissa Fick ◽  
Keong Yap
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychiatric Hospitalization ◽  
Coping Styles ◽  
Psychiatric Inpatients ◽  
Borderline Personality ◽  
Self Report ◽  
Therapeutic Interventions ◽  
Coping Behaviors ◽  
Self Harm

Abstract. Psychiatric hospitalization can cause significant distress for patients. Research has shown that to cope with the stress, patients sometimes resort to self-harm. Given the paucity of research on self-harm among psychiatric inpatients, a better understanding of transdiagnostic processes as predictors of self-harm during psychiatric hospitalization is needed. The current study examined whether coping styles predicted self-harm after controlling for commonly associated factors, such as age, gender, and borderline personality disorder. Participants were 72 patients (mean age = 39.32 years, SD = 12.29, 64% male) admitted for inpatient treatment at a public psychiatric hospital in Sydney, Australia. Participants completed self-report measures of coping styles and ward-specific coping behaviors, including self-harm, in relation to coping with the stress of acute hospitalization. Results showed that younger age, diagnosis of borderline personality disorder, and higher emotion-oriented coping were associated with self-harm. After controlling for age and borderline personality disorder, higher levels of emotion-oriented coping were found to be a significant predictor of self-harm. Findings were partially consistent with hypotheses; emotion-oriented but not avoidance-oriented coping significantly predicted self-harm. This finding may help to identify and provide psychiatric inpatients who are at risk of self-harm with appropriate therapeutic interventions.

Rumination in Borderline Personality Disorder: Meta-Analysis

2018 ◽  
Author(s):  
Mara J. Richman ◽  
Zsolt Unoka ◽  
Robert Dudas ◽  
Zsolt Demetrovics
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Emotion Dysregulation ◽  
Meta Analysis ◽  
Borderline Personality ◽  
Therapeutic Interventions ◽  
Sample Type ◽  
Moderator Variables ◽  
Analytic Review ◽  
Self Harm

Borderline personality disorder (BPD) is characterized by deficits in emotion regulation and affective liability. Of this domain, ruminative behaviors have been considered a core feature of emotion dysregulation difficulties. Despite this, inconsistencies have existed in the literature regarding which rumination type is most prominent in those with BPD symptoms. Moreover, no meta-analytic review has been performed to date on rumination in BPD. Taking this into consideration, a meta-analysis was performed to assess how BPD symptoms correlate with rumination, while also considering clinical moderator variables (i.e., BPD symptom domain, co-morbidities, GAF score) and demographic moderator variables (i.e., age, gender, sample type, and education level). Analysis of correlation across rumination domains for the entire sample revealed a medium overall correlation between BPD symptoms and rumination. When assessing types of rumination, the largest correlation was among pain rumination followed by anger, depressive, and anxious rumination. Among BPD symptom domain, affective instability had the strongest correlation with increased rumination, followed by unstable relationships, identity disturbance, and self-harm/ impulsivity, respectively. Demographic variables showed no significance. Clinical implications are considered and further therapeutic interventions are discussed in the context of rumination.

Frozen child: schema therapy for a forensic patient in a service for men with a diagnosis of severe personality disorder

2016 ◽  
Vol 18 (4) ◽  
pp. 254-264 ◽  
Author(s):  
Asad Ul Lah ◽  
Jacqui Saradjian
Keyword(s):  
Personality Disorder ◽  
Service User ◽  
Single Case ◽  
Schema Therapy ◽  
Content Type ◽  
Protective Strategy ◽  
Personal Reflections ◽  
Participant Observer ◽  
Severe Personality Disorder

Purpose Schema therapy has gone through various adaptations, including the identification of various schema modes. The purpose of this paper is to suggest that there may be a further dissociative mode, the “frozen child” mode, which is active for some patients, particularly those that have experienced extreme childhood trauma. Design/methodology/approach The paper is participant observer case study which is based on the personal reflections of a forensic patient who completed a treatment programme which includes schema therapy. Findings The proposed mode, “frozen child”, is supported by theoretical indicators in the literature. It is proposed that patients develop this mode as a protective strategy and that unless recognised and worked with, can prevent successful completion of therapy. Research limitations/implications Based on a single case study, this concept is presented as a hypothesis that requires validation as the use of the case study makes generalisation difficult. Practical implications It is suggested that if validated, this may be one of the blocks therapists have previously encountered that has led to the view that people with severe personality disorder are “untreatable”. Suggestions are made as to how patients with this mode, if validated, can be treated with recommendations as to the most appropriate processes to potentiate such therapy. Originality/value The suggestion of this potential “new schema mode” is based on service user initiative, arising from a collaborative enterprise between service user and clinician, as recommended in recent government policies.

Non-cancer pain clinic in three English prisons: understanding prisoner needs and prescribing practice in relation to chronic non-cancer pain (CNCP)

2018 ◽  
Vol 14 (4) ◽  
pp. 268-275
Author(s):  
Arun Sondhi ◽  
Tina Garrett
Keyword(s):  
Cancer Pain ◽  
Substance Misuse ◽  
Emotional Health ◽  
Secondary Analysis ◽  
Therapeutic Interventions ◽  
Pain Clinic ◽  
Practical Implementation ◽  
Physical And Mental Health ◽  
Content Type ◽  
Female Patients

Purpose Prisoner access to opiate-based analgesics and gabapentinoids is a concern to prisons through illicit trading. The purpose of this paper is to describe patient needs following introduction of nine pilot chronic non-cancer pain (CNCP) clinics for chronic pain in three prisons (two male and one female) in the South of England. The study evaluated the effectiveness of this model and assessed the wider practical implementation issues. Design/methodology/approach Clinical notes were reviewed for 63 consultations, anonymised and recorded for secondary analysis. Findings Alongside CNCP, high levels of substance misuse, physical and mental health histories were noted, especially for female patients. Amitriptyline, pregabalin, gabapentin were the main frontline analgesics prescribed prior to assessment. A total of 41 per cent of patients did not change their medication following the consultation; 25 per cent had their medication increased or reintroduced (greater for women prisoners); with one-third (33 per cent) of patients reducing the prescription of strong opioids and gabapentinoids. Significant differences were noted between male and female patients. Prisoners were amenable to changes in medication to facilitate access to work and other therapeutic interventions. Social implications The prescribing of analgesics has largely been couched in terms of disruption to the prison regime through illicit trading. This study highlights the need to place CNCP within wider contexts of substance misuse, physical and emotional health. There is an opportunity to develop a rehabilitative rather than palliative approach to pain management. Gender specific approaches for female patients should be considered. Originality/value Few studies of CNCP have been conducted within a prison environment.

Creating communities: the use of technology in craft and DIY communities of practice

2014 ◽  
Vol 16 (4) ◽  
pp. 277-295 ◽  
Author(s):  
Kate Holmes ◽  
Anita Greenhill ◽  
Rachel McLean
Keyword(s):  
Communities Of Practice ◽  
Information And Communication Technologies ◽  
Deep Understanding ◽  
Ethnographic Study ◽  
Original Research ◽  
Structured Interviews ◽  
Content Type ◽  
Use Of Technology ◽  
Theoretical Perspectives ◽  
Insight Into

Purpose – The purpose of this study is to gain insight into craft and do-it-yourself (DIY) communities of practice (COPs) and how the use of technology provides ways for participants to connect, share and create. Gaining deeper insights into the practices of these communities may provide new opportunities to utilise within this flourishing domain. Design/methodology/approach – Qualitative methods were adopted to collect data and analysed through an interpretivist lens. Semi-structured interviews were conducted with members of craft and DIY COPs to gain a deep understanding of the broader ethnographic study. Existing theoretical perspectives surrounding COPs have been applied to further current perspectives. Findings – Findings from this study suggest that being part of a COP allows participants to connect to others, build creative enterprise and learn or enhance skills. Insights gained from this study indicate some of the detailed ways in which the application of technology redefines craft and DIY COPs. Research limitations/implications – This study provides a succinct exploration of a vast and fluid domain; if presented with more time and wider resources, the research would include further exploration of virtual COPs. Originality/value – The investigation provides a rich insight into the use of information and communication technologies (ICTs) within craft and DIY COPs. The application of theoretical perspectives from the area of Information Systems (IS) and Technology Management to this domain is regarded as an original research and furthers knowledge in these areas. Originality/value – The investigation provides a rich insight into the use of ICTs within craft and DIY COPs. The application of theoretical perspectives from the area of IS to the domain of craft and DIY culture is original research and extends existing concepts to include skills sharing as a previously unexplored domain.

scholarly journals The neurodevelopmental trajectory of Borderline Personality Disorder: a review

2018 ◽  
Author(s):  
Siobhan R Edinboro ◽  
Tobias Nolte ◽  
Iris Vilares
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Brain Function ◽  
Emotion Dysregulation ◽  
Grey Matter ◽  
Neural Correlates ◽  
Borderline Personality ◽  
Therapeutic Interventions ◽  
Adult Onset ◽  
Neurodevelopmental Model

Borderline Personality Disorder (BPD) is a complex psychological condition characterised by affective instability, cognitive impairment, problematic behaviours and social dysfunction. Due to the variability in symptomatic profiles, efforts have recently been directed towards comprehending the disorder from a neurological standpoint within the aforementioned domains. Although adolescent-onset BPD is now reliably diagnosed as the adult-onset variant, a limited number of studies address the neural correlates of first presentation BPD. Moreover, research investigating the outcomes of therapeutic interventions on brain function and morphology is scarce. Preliminary findings consistently cite the involvement of grey matter deficiencies of the orbitofrontal cortex, hippocampus and amygdala in the neuropathology of BPD. Additionally, frontolimbic white matter deficits are thought to be implicated. Functionally, over-activity in limbic regions such as the cingulate cortices and amygdala are believed to partially account for emotion dysregulation, though the neural correlates of cognitive, social and behavioural impairments are relatively poorly understood. The present review will endeavour to evaluate the existing neurobiological evidence for BPD in adolescence as well as adulthood. Finally, a rudimentary neurodevelopmental model of BPD will be proposed.

Organisational effectiveness and personality disorder

2015 ◽  
Vol 20 (2) ◽  
pp. 84-91 ◽  
Author(s):  
Jane Yeandle ◽  
Liz Fawkes ◽  
Clare Carter ◽  
Chris Gordon ◽  
Elizabeth Challis
Keyword(s):  
Personality Disorder ◽  
Service Delivery ◽  
Treatment Guidelines ◽  
Clinical Excellence ◽  
Emotional Reactions ◽  
Service Development ◽  
Content Type ◽  
Organisational Effectiveness ◽  
Client Group ◽  
Organisational Factors

Purpose – National treatment guidelines regarding Borderline Personality Disorder (BPD) (National Institute for Health and Clinical Excellence, 2009) make a number of recommendations relating to system and cultural treatment variables including: access to services, autonomy and choice, developing an optimistic and trusting relationship and managing endings and transitions. The purpose of this paper is to look at a model which could help organisational effectiveness across a range of service settings in relation to personality disorder. Design/methodology/approach – Explanation of why the McKinsey 7S organisational model (Waterman et al., 1980) may be useful in assessing organisational effectiveness in relation to personality disorder. Findings – Cultural and organisational factors across a range of levels need to be aligned to allow for effective service delivery. This is particularly important in working with this client group where strong emotional reactions and subsequent organisational splits are common. Practical implications – The application of this tool within clinical leadership and service development would be particularly important for coherence within generalist (as opposed to specialist) settings. Originality/value – To the authors’ knowledge this analysis is unique as a review of NHS culture across a range of settings and discussion of the implications for service delivery for patients with BPD.

Failures to Imagine

2016 ◽  
Vol 36 (3) ◽  
pp. 270-300 ◽  
Author(s):  
Reed Maxwell ◽  
Steven Jay Lynn ◽  
Scott Lilienfeld
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mental Imagery ◽  
Emotional Regulation ◽  
Preliminary Evidence ◽  
Borderline Personality ◽  
Self Report ◽  
Future Research ◽  
Cross Sectional ◽  
Visual Mental Imagery

Although interest in the relationship between mental imagery and psychopathology has increased greatly over the last decade, few publications to date have examined relationships between personality-related psychopathology and mental imagery use, abilities, or both. However, we have reason to expect that substantive relationships may exist. For example, studies have consistently linked psychopathy and borderline personality disorder to problems in emotion experience and emotion regulation, and a growing number of studies indicate that deficits in visual mental imagery use and ability in particular may contribute to such problems. Using correlational data from multiple self-report measures of normal and pathological personality functioning and visual mental imagery, our study presents preliminary evidence for lower levels of self-reported visual mental imagery use, abilities, or both among noncriminal individuals with higher levels of self-reported psychopathy and individuals with greater emotional regulation difficulties, a core feature of borderline personality disorder. We also found significant relationships among self-reported visual mental imagery use, ability, or both, and personality variables shown to strongly predict psychopathy and emotional regulation difficulties. Limitations of the study, especially its reliance on a correlational, cross-sectional design, are discussed, and implications for future research are explored.

scholarly journals The effect of IC components on innovation performance in Serbian companies

2018 ◽  
Vol 48 (3) ◽  
pp. 448-466 ◽  
Author(s):  
Sladjana Cabrilo ◽  
Aino Kianto ◽  
Bojana Milic
Keyword(s):  
Structural Equation ◽  
Deep Understanding ◽  
Business Environment ◽  
Innovation Performance ◽  
Equation Modeling ◽  
Content Type ◽  
Innovative Performance ◽  
Positive Effects ◽  
Innovation Potential ◽  
Structural Capital

Purpose In investigating the linkage between intellectual capital (IC) and innovation, it is important not only to explore how IC as a whole is associated with organizations’ innovative performance but also to gain a deep understanding of the role of different IC components (groups of intangibles) in companies’ innovation performance, which is the purpose of this paper in the context of Serbian companies. Design/methodology/approach This research is based on survey data collected from 100 Serbian companies with at least 100 employees during 2014/2015. Six IC components were analyzed (human, structural, internal relational, external relational, renewal and entrepreneurial) in terms of their effect on innovation performance. Analyses were conducted using structural equation modeling and correlation analysis. Findings Findings demonstrate that renewal capital, internal relational capital and structural capital have statistically significant positive effects on overall innovative performance in Serbian companies. Practical implications The outcomes reveal potential and barriers within IC that are crucial to innovation performance in Serbian companies. In this way, this study enables a deeper understanding of intangible drivers of innovation and highlights possibilities to foster intangible innovation potential in Serbian companies. Originality/value As context (economic and cultural) has emerged as a relevant factor in researching IC, this study is original in investigating IC effect on innovation within the Serbian business environment. Additionally, the broad sexpartite taxonomy of IC contributes to a wider understanding of knowledge and its linkages to innovation.

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