Clinician perspectives on recovery and borderline personality disorder

2017 ◽  
Vol 12 (3) ◽  
pp. 199-209 ◽  
Author(s):  
Fiona Donald ◽  
Cameron Duff ◽  
Katherine Lawrence ◽  
Jillian Broadbear ◽  
Sathya Rao
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Thematic Analysis ◽  
Psychosocial Functioning ◽  
Mental Healthcare ◽  
Borderline Personality ◽  
Theory Approach ◽  
Content Type ◽  
Clinician Perspectives ◽  
Strong Position

Purpose Recovery is an important concept within mental healthcare policy. There is a growing expectation that clinicians adopt approaches that align with the recovery principles, despite significant disagreements about what recovery-oriented interventions might look like in practice. It is also unclear how recovery may be relevant to personality disorder. This paper aims to discuss these issues. Design/methodology/approach In total, 16 clinicians were interviewed at two mental health services in Melbourne, Australia. These clinicians had specialist training and experience in the treatment of borderline personality disorder (BPD) and provided insight regarding the meaning and relevance of the recovery paradigm in the context of BPD. Thematic analysis within a grounded theory approach was used to understand key themes identified from the interview data. Findings Thematic analysis suggested that clinicians understand recovery in three distinct ways: as moving towards a satisfying and meaningful life, as different ways of relating to oneself and as remission of symptoms and improved psychosocial functioning. Clinicians also identified ways in which recovery-related interventions in current use were problematic for individuals diagnosed with BPD. Different approaches that may better support recovery were discussed. This study suggests that practices supporting recovery in BPD may need to be tailored to individuals with BPD, with a focus on cultivating agency while acknowledging the creative nature of recovery. Originality/value Clinicians are in a strong position to observe recovery. Their insights suggest key refinements that will enhance the ways in which recovery in BPD is conceptualized and can be promoted.

scholarly journals Engagement Complications of Adolescents with Borderline Personality Disorder: Navigating Through a Zone of Turbulence

2020 ◽  
Author(s):  
Lyne Desrosiers ◽  
Micheline St-Jean ◽  
Lise Laporte ◽  
Marie-Michèle Lord
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Health Care Services ◽  
Subjective Experience ◽  
Therapeutic Process ◽  
Borderline Personality ◽  
Warning Signs ◽  
Constructivist Grounded Theory ◽  
Grounded Theory Method

Abstract Objective: Premature treatment discontinuation is a widespread phenomenon in child and adolescent mental health services that impacts treatment benefits and costs of care. Adolescents with borderline personality disorder (BPD) are heavy users of health care services and notoriously difficult to engage in treatment. However, there is hardly any data regarding this phenomenon with these youths. Considering that BPD treatment is associated with intense and chaotic therapeutic processes, exploring barriers emerging in the course of treatment could be relevant. Thus, conceptualizing treatment dropout as a process evolving from engagement to progressive disengagement, and ultimately to dropout, could highlight the mechanisms involved. The aim of this study was to describe the process of treatment disengagement and identify warning signs that foreshadow dropouts of adolescents with BPD. Method: A constructivist grounded theory method was used. This method has been favoured based on the assumption that the behaviours and decisions leading to disengagement may be better informed by the subjective experience of treatment. Thirty-three interviews were conducted to document 11 treatment trajectories with 3 groups of informants (9 adolescents with BPD 13-17 of age, 11 parents, and 13 clinicians). Results: Well before dropout occurs, different phenomena identified as “engagement complications” characterize the disengagement process. These unfold according to a three-step sequence starting with negative emotions associated with the appropriateness of treatment, the therapeutic relationship or the vicissitudes of treatment. These emotions will then generate treatment interfering attitudes that eventually evolve into openly disengaged behaviours. These complications, which may sometimes go unnoticed, punctuate the progression from treatment engagement to disengagement leading the way towards the development of a “zone of turbulence” which creates a vulnerable and unstable therapeutic process presenting risk for late dropout. Conclusion: Engagement of adolescents with BPD is neither static nor certain, but on the contrary, subject to their fluctuating perceptions. Therefore, it can never be taken for granted. Clinicians must constantly pay attention to emergent signs of engagement complications. Maintaining the engagement of adolescents with BPD should be a therapeutic objective akin to reducing symptomatology or improving psychosocial functioning, and should therefore be given the same attention.

Meaningful Ways of Understanding and Measuring Change for People with Borderline Personality Disorder: A Thematic Analysis

2018 ◽  
Vol 46 (5) ◽  
pp. 528-540 ◽  
Author(s):  
Louise McCusker ◽  
Marie-Louise Turner ◽  
Georgina Pike ◽  
Helen Startup
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Focus Groups ◽  
Thematic Analysis ◽  
Borderline Personality ◽  
Complex Nature ◽  
Service Users ◽  
Starting Point ◽  
Wide Range ◽  
Measuring Change

Background:The effective treatment of Borderline Personality Disorder (BPD) presents healthcare providers with a significant challenge. The evidence base remains limited partially due to a lack of professional consensus and service user involvement regarding ways of measuring change. As a result, the limited evidence that is available draws on such a wide range of outcome measures, that comparison across treatment types is hindered, maintaining a lack of clarity regarding the clinical needs of this group.Aims:This investigation aimed to follow the National Institute of Clinical Excellence (NICE, 2009) research recommendations by asking service users about meaningful change within their recovery. This forms a starting point for the future development of a tailored outcome measure.Method:Fifteen service users with a diagnosis of BPD participated in three focus groups across two specialist Personality Disorder services. The focus groups were analysed using Thematic Analysis.Results:Two superordinate themes were synthesized from the data: (1) recovery to what?: ‘How do you rewrite who you are?’; and (2) conditions for change. Each superordinate theme further consisted of three subordinate themes which elucidated the over-arching themes.Conclusion:This investigation highlights the complex nature of measuring change in people who have received a BPD diagnosis. Further research is needed to develop meaningful ways of measuring change according to the needs and priorities of people with BPD.

Inpatient treatment of borderline personality disorder in adults with intellectual disability: reflections on practice

2019 ◽  
Vol 13 (2) ◽  
pp. 67-75
Author(s):  
Trine Elisabeth Iversen ◽  
Kristin Horndalsveen ◽  
Espen Matre ◽  
Tine Finstad Henriksen ◽  
Sarah Fusche ◽  
...  
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Inpatient Treatment ◽  
Borderline Personality ◽  
Behaviour Problems ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Content Type

Purpose There are few publications on personality disorder in adults with intellectual disability (ID), and on borderline personality disorder (BPD) specifically. Publications concerning treatment are sparse, despite the high symptom burden in these patients. This paper aims to discuss these issues. Design/methodology/approach Six patients with BPD and ID were recruited from the same inpatient unit. Behaviour problems and mental health symptoms were scored on admission and discharge. Information about treatment, length of stay, etc. was taken from case files. Findings Both mental health symptoms measured by the SCL-90-R, and behaviour problems measured by the Aberrant Behaviour Checklist were significantly reduced on discharge. In the active treatment period, the two main aspects of treatment were validation and practicing new solutions when emotional and behavioural problems occur, i.e. skills training. Research limitations/implications The limitations related to this study are that the study is conducted in one milieu only. Another limitation is that the patients were admitted over a five-year period, where, some changes were made in the treatment approach. Practical implications Inpatient treatment of this patient group seems to be effective if individually adjusted to the patient’s psychopathology, ID and communication style. Close co-operation between the individual therapist and milieu therapists is essential. Originality/value There is a need for intervention studies on BPD in ID. This study may be a valuable contribution.

scholarly journals Impact of Psychotherapy on Psychosocial Functioning in Borderline Personality Disorder Patients

2020 ◽  
Vol 17 (12) ◽  
pp. 4610 ◽  
Author(s):  
Soheil Zahediabghari ◽  
Philippe Boursiquot ◽  
Paul Links
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Social Adjustment ◽  
Psychosocial Functioning ◽  
Meta Analysis ◽  
Intervention Group ◽  
Borderline Personality ◽  
Self Report ◽  
Reference List ◽  
General Functioning

Borderline Personality Disorder (BPD) significantly impairs functioning. Fortunately, effective treatments are available for borderline symptoms but their effect on functioning should be assessed. The objective of this meta-analysis is to assess the effect of specifically-designed versus non-specifically designed psychotherapies on function in adult patients with BPD. The reference list of Cristea et al. 2017 was used to identify the randomized controlled trials (RCTs) assessing the BPD-specifically-designed psychotherapy versus non-specific psychotherapies in adult BPD patients. Among those, RCTs assessing post-treatment functioning using the Global Assessment of Functioning, Social Adjustment Scale–Self-Report and Inventory of Interpersonal Problems were included. Ten trials (880 participants) were included. Summary effect size was calculated using the measured Hedge’s g. The results indicate the BPD patients in the intervention group had a significantly higher (g = 0.41; 95% CI, 0.09–0.73) level of psychosocial functioning after receiving the specifically-designed psychotherapies in comparison with BPD patients in control groups after receiving non-specific psychotherapies. Specifically-designed psychotherapies can improve psychosocial functioning although improvement in measurement of function (i.e., more objective and universal tools) and improvement in psychotherapies (i.e., more focused on general functioning) will be helpful.

scholarly journals Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial

2010 ◽  
Vol 196 (5) ◽  
pp. 389-395 ◽  
Author(s):  
Stephan Doering ◽  
Susanne Hörz ◽  
Michael Rentrop ◽  
Melitta Fischer-Kern ◽  
Peter Schuster ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Randomised Controlled Trial ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Controlled Trial ◽  
Borderline Personality ◽  
Patient Treatment ◽  
Significant Group ◽  
Randomised Controlled ◽  
Transference Focused Psychotherapy

BackgroundTransference-focused psychotherapy is a manualised treatment for borderline personality disorder.AimsTo compare transference-focused psychotherapy with treatment by experienced community psychotherapists.MethodIn a randomised controlled trial (NCT00714311) 104 female out-patients were treated for 1 year with either transference-focused psychotherapy or by an experienced community psychotherapist.ResultsSignificantly fewer participants dropped out of the transference-focused psychotherapy group (38.5% v. 67.3%) and also significantly fewer attempted suicide (d = 0.8, P = 0.009). Transference-focused psychotherapy was significantly superior in the domains of borderline symptomatology (d = 1.6, P = 0.001), psychosocial functioning (d = 1.0, P = 0.002), personality organisation (d = 1.0, P = 0.001) and psychiatric in-patient admissions (d = 0.5, P = 0.001). Both groups improved significantly in the domains of depression and anxiety and the transference-focused psychotherapy group in general psychopathology, all without significant group differences (d = 0.3–0.5). Self-harming behaviour did not change in either group.ConclusionsTransference-focused psychotherapy is more efficacious than treatment by experienced community psychotherapists in the domains of borderline symptomatology, psychosocial functioning, and personality organisation. Moreover, there is preliminary evidence for a superiority in the reduction of suicidality and need for psychiatric in-patient treatment.

scholarly journals Developmental Trajectories of Borderline Personality Disorder Symptoms and Psychosocial Functioning in Adolescence

2016 ◽  
Vol 30 (3) ◽  
pp. 351-372 ◽  
Author(s):  
Aidan G. C. Wright ◽  
Maureen Zalewski ◽  
Michael N. Hallquist ◽  
Alison E. Hipwell ◽  
Stephanie D. Stepp
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Developmental Trajectories ◽  
Borderline Personality

Having a diagnosis of borderline personality disorder in a forensic setting: a qualitative exploration

2014 ◽  
Vol 16 (3) ◽  
pp. 228-240 ◽  
Author(s):  
Lucy Jade Lovell ◽  
Gillian Hardy
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Lived Experience ◽  
Interpretative Phenomenological Analysis ◽  
Sense Of Self ◽  
Borderline Personality ◽  
Power Dynamics ◽  
Structured Interviews ◽  
Content Type ◽  
Forensic Setting

Purpose – The purpose of this paper is to explore the lived experience of having a diagnosis of Borderline Personality Disorder (BPD) in a forensic setting. Design/methodology/approach – Semi-structured interviews were conducted with eight women with a diagnosis of BPD in private secure units. The interview data were analysed using interpretative phenomenological analysis (IPA). Findings – Four main themes emerged: identity, power, protection and containment, and confusion. The themes of identity, power and protection and containment represented polarised positions which in turn contributed to the theme of confusion. Research limitations/implications – There are limitations to this study mainly the heterogeneous nature of the sample. However, good quality control and the similarities with previous findings indicate that this study makes a valuable contribution to the understanding of BPD in a forensic setting. In addition it has implications for further research; exploring sense of self and the differences between a sample from a community and a sample from a forensic setting with a diagnosis of BPD. Practical implications – For practitioners to acknowledge power dynamics and to be able to formulate and address these with patients with a diagnosis of BPD. Originality/value – This is the first IPA study to ask women with a diagnosis of BPD in a forensic setting what their experience is. It is a qualitative study due to the need to genuinely explore the topic and to provide a basis for others to conduct further research.

Borderline personality disorder and parenting: clinician perspectives

2015 ◽  
Vol 13 (2) ◽  
pp. 113-126 ◽  
Author(s):  
Dianna R Bartsch ◽  
Rachel M Roberts ◽  
Matthew Davies ◽  
Michael Proeve
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Clinician Perspectives

scholarly journals Service user experiences of mentalisation-based treatment for borderline personality disorder

2017 ◽  
Vol 22 (1) ◽  
pp. 16-27 ◽  
Author(s):  
Diarmaid Ó. Lonargáin ◽  
Suzanne Hodge ◽  
Rachael Line
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Interpretative Phenomenological Analysis ◽  
Service User ◽  
Borderline Personality ◽  
Individual Therapy ◽  
Future Research ◽  
User Experiences ◽  
Content Type ◽  
The Uk

Purpose Previous research indicates that mentalisation-based treatment (MBT) is an effective therapeutic programme for difficulties associated with borderline personality disorder (BPD). The purpose of this paper is to explore service user experiences of the therapy. Design/methodology/approach Seven adults (five female and two male), recruited via three NHS trusts, were interviewed. Participants were attending intensive out-patient MBT for BPD between 3 and 14 months. Data were analysed using interpretative phenomenological analysis. Findings Participants experienced the group component of MBT as challenging and unpredictable. They highlighted developing trust as key to benefitting from MBT. This was much more difficult to achieve in group sessions than in individual therapy, particularly for those attending MBT for less than five or six months. The structure of MBT generally worked well for participants but they identified individual therapy as the core component in achieving change. All participants learned to view the world more positively due to MBT. Practical implications Enhanced mentalisation capacity may help address specific challenges associated with BPD, namely, impulsivity and interpersonal difficulties. MBT therapists are confronted with the ongoing task of creating a balance between sufficient safety and adequate challenge during MBT. Potential benefits and drawbacks of differing structural arrangements of MBT programmes within the UK are considered. Originality/value Learning about service user perspectives has facilitated an enhanced understanding of experiences of change during MBT in addition to specific factors that may impact mentalisation capacity throughout the programme. These factors, in addition to implications for MBT and suggestions for future research, are discussed.

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