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

PRACTICAL GUIDANCE
RECEIVING GOOD CARE, IN WHATEVER SITUATION, CAN BE
A TURNING POINT IN A PERSON’S LIFE.
It is very important, when working with a person with
personality disorder, to be clear about what your ‘primary
task’ is. The primary task is what you are being employed to
achieve by your organisation. If you are a housing support
worker, your primary task may be to help the service user to
obtain and maintain a housing tenancy. If you are a social
worker in a children’s social care team, your primary task is
to reduce the risk of harm to children in the family. If you are
a worker in a community mental health team your primary
task may be to help the service user to reduce their
vulnerability to crises.
Whatever your primary task, it can be more difficult to achieve
when the service user has a personality disorder. Their anxieties
about relationships may make it difficult to engage them with
the primary task. Their problems in managing their behaviour
are likely to affect the professional relationship.
A worker needs additional capabilities, above and beyond the
core capabilities required for the primary task. These additional
capabilities centre on the relationship between service user and
worker. This needs to be one in which both parties recognise,
openly acknowledge and support the development of personal
agency for the service user. Personal agency means that the
service user takes responsibility for their actions but in a context
which is non-blaming, non-judgmental, and compassionate
towards the difficulties they have in doing this.
How can personal
agency be
developed and
supported?
The most effective forms of
therapy for people with
personality disorder all tackle
this issue of personal agency,
so we can learn from them how
to develop and support it.
It helps to be explicit about the
primary task and clearly define
how you will both know when
this has been achieved. This
prevents a ‘drift’ in the direction
of general support (although
occasionally providing general
support may actually be the
primary task, particularly during
transitions or life-events).
It is also very important to try
to carefully position yourself in
the relationship so that you are
neither overly supportive nor
overly demanding – expecting
the service user to demonstrate
more independence and
competence than they are
capable of at that point in time.
Sometimes we call this being not
too close and not too distant.
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