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

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ANTISOCIAL PERSONALITY DISORDER Antisocial personality disorder is often linked in people’s minds with criminal behaviour, and around 50% of people in prisons might meet criteria for antisocial personality disorder; however, only 47% of the people who meet criteria for antisocial personality have significant arrest records (NICE CG77, 2009). <strong>The</strong> companion guide to this one,‘Working with Offenders with Personality Disorders in the Community’ (Ministry of Justice, 2011; www.justice.gov.uk) contains a great deal of helpful information and advice about working with offenders with personality disorders, whether this is antisocial or other personality disorders. Whether or not someone with antisocial personality disorder has a criminal record, all people with antisocial personality disorder have mental health needs, and antisocial personality disorder is often co-morbid with depression, anxiety and alcohol and drug use. <strong>The</strong> NICE guideline for antisocial personality disorder (ASPD) spells out some recommendations for good practice: • People with ASPD tend to be excluded from services and staff should work actively to engage them. • Positive and reinforcing approaches to treatment are more likely to be helpful than those that are negative or punitive. • Work in partnership with people with ASPD in order to develop their autonomy by encouraging them to be actively involved in finding solutions to their problems, even when in crisis, and encouraging them to consider different treatment options or life choices available to them, and the consequences of choices that they make. • Provision of services for people with ASPD often involves significant interagency working. Pathways between services should be clear, and communication between organisations should be effective. • Pharmacological interventions (drug treatments) should not be routinely used for the treatment of antisocial personality disorder or associated behaviours of aggression, anger and impulsivity. Pharmacological interventions for comorbid mental disorders, in particular depression and anxiety, should be in line with recommendations in the relevant NICE clinical guideline. As yet there is limited evidence about effective treatments for antisocial personality disorder. This does not mean that ‘nothing works’, only that this group are less easily studied than, say, people with anxiety symptoms or depression, and interventions have tended to focus on reducing criminal behaviour rather than treating the underlying personality difficulties. NICE recommend group based cognitive and behavioural interventions focused on reducing offending and other antisocial behaviour, and to address problems such as impulsivity and interpersonal difficulties. As more research is conducted on helpful treatments for people with personality disorder, it may well be that the recommendations for effective treatments for people with ASPD will broaden to include a wider range of treatment options. 56
Learning points from Chapter 5 — — — — — — Someone who struggles with forming and sustaining relationships will find it difficult to make a relationship with a person who is trying to help them, so the worker will need an understanding of the service user’s anxieties about seeking help. It’s helpful to know what services are available in your locality for people with personality disorder. Talk to the service user about what sort of help they would prefer – some people prefer to get help from voluntary agencies or online resources, whereas others may want professional or specialist help. Medication is not recommended for the treatment of the two most common personality disorders, antisocial and borderline personality disorder, but it may be useful to treat symptoms such as depression or anxiety which are associated with the personality disorder or related disorders. All psychological therapies for people with personality disorders take into account the childhood history of the person, difficulties they may have in engaging with therapy, as well as problems they may have around endings or moving on. Care plans, developed with the service user, should include short and long-term goals as well as a crisis plan, and should normally be shared with the GP. Contact with services should be medium or long-term, hopeful, collaborative and empowering. 57
Page 1 and 2:
Working effectively to support peop
Page 3 and 4:
Contents Foreword .................
Page 5 and 6:
Executive summary It’s not person
Page 7 and 8: INTRODUCTION THE PURPOSE OF THIS GU
Page 9 and 10: WORKING TOGETHER Professionals have
Page 11 and 12: BACKGROUND Each person’s personal
Page 13 and 14: BACKGROUND • People with personal
Page 15 and 16: BACKGROUND taken overdoses is stock
Page 17 and 18: BACKGROUND How do we describe and u
Page 19 and 20: BACKGROUND 1) Openness (seeking out
Page 21 and 22: BACKGROUND “Music has got me thro
Page 23 and 24: LEARNING POINTS FROM CHAPTER 1 —
Page 25 and 26: BACKGROUND There is no underlying
Page 27 and 28: BACKGROUND The notion of treatabili
Page 29 and 30: BACKGROUND For many years, because
Page 31 and 32: Learning points from Chapter 2 —
Page 33 and 34: BACKGROUND Most professionals agree
Page 35 and 36: BACKGROUND soothing, responsive car
Page 37 and 38: BACKGROUND THE THEORY OF MENTALIZAT
Page 41 and 42: PRACTICAL GUIDANCE RECEIVING GOOD C
Page 43 and 44: PRACTICAL GUIDANCE What might get i
Page 45 and 46: PRACTICAL GUIDANCE THERE ARE MANY R
Page 47 and 48: PRACTICAL GUIDANCE HELPFUL THINGS T
Page 51 and 52: PRACTICAL GUIDANCE Here are some ex
Page 53 and 54: PRACTICAL GUIDANCE Some teams will
Page 55 and 56: PRACTICAL GUIDANCE Specific psychol
Page 57: PRACTICAL GUIDANCE borderline and a
Page 61 and 62: PRACTICAL GUIDANCE There are many d
Page 63 and 64: PRACTICAL GUIDANCE It is extremely
Page 65 and 66: PRACTICAL GUIDANCE 6) ISSUES OF POW
Page 69 and 70: PRACTICAL GUIDANCE We all know that
Page 71 and 72: PRACTICAL GUIDANCE Common defences
Page 73 and 74: PRACTICAL GUIDANCE It is possible t
Page 75 and 76: PRACTICAL GUIDANCE ORGANISATIONAL V
Page 79 and 80: therapist and client is a collabora
Page 81 and 82: Appendix 2: References and resource
Page 83 and 84: SELF HARM: National Self Harm netwo
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Meeting-The-Challenge-Making-a-Difference-Practitioner-Guide

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