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

Many people want help, yet
also fear getting involved or
dependent, and this may
lead them to feel hostile
towards someone who is
offering help. The worker
needs to be able to
understand what lies behind
apparent reactions of
hostility or lack of interest
on the part of the service
user. Workers will also need
to have the skill to work
constructively with a service
user when something seems
to have gone wrong or the
person disengages from the
therapy or the service.
• Knowledge of self and
other. Staff working with
people with personality
disorders need to be good at
understanding others, but
also need to have a good
knowledge of themselves.
People with personality
disorders are often very
sensitive to the way others
treat them, and workers
need to be aware of how
they, the worker, comes
across and the impact they
have on others.
“I knew I needed help, I asked for help but when I got a
social worker I didn’t trust them to be able to understand
or care about me. For a long time I was testing her to
see how she responded and even after that went
through phases of drawing her in and pushing her
away. My whole life experience up ‘til then had
taught me that other people couldn’t cope with my
emotions and getting close to someone would cause
me pain. My behaviour exasperated my social worker
so much, she did what I had always expected her to
and handed me over to someone else in the team,
with a warning that I was difficult, i.e. she left.”
• Helping people shift from action to thought. People with personality
disorders may at times resort to action when they cannot bear to
think about their feelings, or don’t know what to do with their
feelings.This may be particularly true of people with more ‘impulsive’
personality disorders like borderline or antisocial personality disorder.
Someone who feels they have been shown up and humiliated may
become very angry or violent; someone who feels very pent up and
distressed may harm themselves because they don’t know what else
to do, and they find that self-harm gives a feeling of release or relief.
Psychological therapies for people with personality disorders usually
include ways of helping the person to think about, and speak
about their feelings, rather than expressing them through actions.
• Understanding and managing transitions, endings and loss.
If someone has a history of being rejected or abandoned, or
feeling unsafe in relationships, he or she may find endings of
relationships particularly difficult. Any therapy for people with
personality disorders will not only help people to cope with
endings or losses they are facing or have experienced in their
lives, but should also pay attention to how the service user will
manage the end of the contact. With good quality psychological
therapies, the ending of the therapy is planned in advance, the
therapy is often longer than for other types of problems, and
the therapist will pay attention to the range of feelings which
the client has about ending, and where they will obtain support
after the therapy has finished.
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