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

Contents
Foreword .................................................................................................................................................................2
Executive summary ................................................................................................................................................3
Introduction...........................................................................................................................................................4
BACKGROUND
1 What do we mean when we talk about ‘personality disorder’? ...................................................................8
How do I recognise when someone has a personality disorder? ..................................................................10
What do you do if you identify that someone has personality difficulties? .................................................12
How do we describe and understand these problems? .................................................................................15
Thinking about the individual and arriving at a formulation of their difficulties.........................................18
2 Why is the diagnosis of personality disorder so controversial?..................................................................22
Stigma ...............................................................................................................................................................23
The notion of treatability.................................................................................................................................25
It matters how a diagnosis is given ................................................................................................................26
It’s not the label that matters but what happens afterwards.....................................................................27
Supporting someone through the process of receiving the diagnosis .........................................................28
3 How does personality disorder develop? ......................................................................................................30
What is biological sensitivity?...........................................................................................................................31
Early experiences with important others ........................................................................................................32
How does failure to meet core needs contribute to personality disorder? ..................................................34
Broader social and environmental factors......................................................................................................35
Life course of personality disorder ..................................................................................................................36
PRACTICAL GUIDANCE
4 What can I do to make a difference? ...........................................................................................................38
How can personal agency be developed and supported? ............................................................................39
What might get in the way of achieving a boundaried relationship?...........................................................41
How can we deal with challenging behaviour?..............................................................................................42
Self harm...........................................................................................................................................................42
5 What help might be available? ......................................................................................................................48
What do the NICE guidelines advise? .............................................................................................................54
6 Service user involvement ................................................................................................................................58
What are the types of service user involvement? ..........................................................................................59
What are the principles of good service user involvement? .........................................................................62
What are the challenges associated with service user involvement? ..........................................................64
What are the benefits associated with service user involvement? ..............................................................64
7 Surviving or thriving at work? What helps staff?........................................................................................66
Wellbeing and burnout....................................................................................................................................68
What do you need in order to do this work?..................................................................................................69
Developing your capacity to work with people with personality disorders ..................................................70
Working in teams ..............................................................................................................................................71
Appendix 1: Specific psychological therapies which may be available
for people with personality disorders.............................................................................................76
Appendix 2: References and resources ..............................................................................................................79
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