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

PRACTICAL GUIDANCE
Some teams will put quite a
lot of emphasis on arriving at
a diagnosis (see Chapter 2
‘Why is the diagnosis so
controversial?’), while others
will put more emphasis on
arriving at a plan with the
service user about what the
issues are that they need help
with. If the service user is
unhappy about the way
they are being described or
treated, it is usually helpful
to speak up and to try and
have a conversation about
their concerns.
Structured clinical
management, or
structured clinical care
Current best practice in
relation to standard care for
someone with complex needs
or personality disorder is
‘structured clinical
management’ or ‘structured
clinical care’. This is different
from some traditional mental
health care approaches. It is
structured, involves regular
agreed appointments, is timelimited
(even though possibly
of long duration) and seeks to
establish agreement with the
service user about what they
would like to get out of their
care. This would include
thinking about how they
would like their life to be, what
problems need to be resolved
to achieve this, and how to
approach solving these
problems. It treats the service
user as an active and
responsible participant in their
care, not as a passive recipient
and is, therefore, very much a
collaborative, shared
enterprise. It may involve some
motivational work, and some
help in managing intense
emotions and impulsive
behaviour. Sometimes service
users attend problem solving
groups as well as one to one
appointments.
The care plan should always
include a crisis plan so that if
the person experiences a
worsening of their problems,
they and other people involved
in their care, have an
agreement about how to
manage this, and where they
should turn for help if they
can’t manage on their own.
For many service users,
structured clinical care provides
an effective way to meet their
needs and support their
progress at a comfortable
pace. For other people, more
intensive treatment might be
needed and specific
psychological therapies may
be considered.
3) SPECIALIST PSYCHOLOGICAL
THERAPIES FOR
PERSONALITY DISORDER.
Psychological therapies or
‘talking therapies’ for
personality disorder all share
some common elements:
• Recognizing the influence
of the past on the present.
The therapy will take into
account the individual’s
history, their experience of
close relationships in early
childhood, the patterns of
relating which they have
established, and the impact on
them of any trauma they have
experienced, particularly
when growing up.
• Acknowledging and
working with difficulties
in engagement. Someone
who struggles with forming
or sustaining relationships, or
who often feels hurt,
threatened or misunderstood
in relationships, will often
find it difficult to make a
relationship with a person
who is trying to help them.
The worker will need to be
compassionate and have
an understanding of the
service user’s anxieties about
seeking help and to be able
to work with the conflicting
feelings which the person
has about seeking help.
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