Meeting-The-Challenge-Making-a-Difference-Practitioner-Guide

BACKGROUND
“Music has got me
through some of the
most difficult times of
my life, I don’t have
any family and find
friendships complicated,
but sometimes when
I have hit a crisis,
I find solace and
understanding in music.
This ‘connection’ that
I find in music has been
‘there’ for me in a way
no actual person has.”
These five P’s are different from
the three P’s described earlier,
for identifying personality
problems (persistent, pervasive
and problematic). If you can
work with the individual in your
service to identify these ‘five
P’s’, it will provide a sound
initial framework for thinking
about the person, what might
be affecting them, and where
there might be scope to help
them to make changes. It is
usually difficult to change the
predisposing factors because
these are part of someone’s
history, but you may be able to
help the person to avoid or
challenge the precipitating
and perpetuating factors, or
to strengthen the protective
factors in their lives.
Cultural
differences and
value judgments
The judgments we make
about desirable and
undesirable personality
traits are sometimes very
subjective, and reflect our
own cultural context. In one
culture, young people
breaking away from their
families and showing
independence may be seen
as mature and impressive; in
another culture, continuing
dependence on and close
involvement with the family
may be praised and seen as
a mark of health. This is one
reason why staff in mental
health services and other
agencies who work with
people with personality
disorder need to engage in
‘reflective practice’ with
others. They need the
opportunity to check out
their judgments with a range
of others to guard against
the possibility of their own
cultural attitudes negatively
influencing their perceptions
of service users.
“When I first saw a
psychiatrist I was a young
gay woman, embedded in
gay culture – that was my
‘normal’ so when I saw
in my notes that my short
hair and boyish clothes
were written about as a
sign of something weird,
I flipped out. The
psychiatrist was an old,
straight, white man –
what the hell did he know
of my culture? If he’d ever
been to a gay club he
would have known that
I looked like most of the
other women there. To
his credit, once I calmed
down and explained this,
he did remove that section
from my notes. But it
made me wonder what
other assumptions had
been made about me...”
The definition of personality
disorder given in DSM IV states
that there must be an
“enduring pattern of inner
experience and behavior that
deviates markedly from the
expectations of an individual’s
given culture”, but in today’s
complex world we often engage
with more than one culture.
19