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

PRACTICAL GUIDANCE
It is extremely common for people with personality difficulties to
struggle with problems of identity; many people find it impossible
to hold onto a sense of who they are. As people progress through
treatment this can become more pronounced; as past coping
strategies are left behind, people often ask ‘what’s left?’‘Who am
I if I’m no longer ‘a self harmer’ or ‘an alcoholic’ or ‘the crazy one?’
Involvement activities can provide a space for people to begin to
explore new roles and ways of relating to people. This uncertainty
about identity is a core feature of the experience of personality
disorder, so there is immense therapeutic potential in providing
spaces where this can be experimented with.
One of the most misunderstood aspects of personality disorder is
that individuals who attract the diagnosis may be bright, articulate
and have extremely high functioning sides alongside the poorer
functioning and the complex emotional difficulties associated
with their diagnosis. These ‘opposites’ can pose a number of
challenges for service users and practitioners alike. Sometimes
there is surprise or shock at just how well someone can contribute:
“I was invited to sit on a clinical improvement group for
my community mental health team, chaired by the
senior medical consultant of the team. At the end of
my first meeting, the consultant turned his head to me
and said ‘I’m surprised, you made a very valuable
contribution to the meeting’, what did he expect a
service user to do, sit and dribble in a corner? That
comment made me realise that the expectations of
service users were low and involvement was a tick box
exercise… they genuinely didn't expect a service user
could make a valuable contribution. I then went on to
think, if this was the view of the head consultant, what
sort of example was he setting for the rest of the
team? And no wonder the service was poor. I felt his
back-handed compliment was humiliating and
disrespectful and subsequently lost all hope in the
service to help or understand me or others like me.”
Although the growth of
authentic and meaningful
service user involvement in the
field of personality disorder has
been problematic, there is
nonetheless room for immense
optimism when both the concepts
of personality disorder and
involvement are understood
and worked with appropriately
as Haigh et al (2007) describe:
“Many users of services may have
a complex history of abuse,
neglect or rejection and the
opportunity to embark upon
activities that shape and direct
the services they receive
promotes inclusion and
therapeutic growth in itself.
Many service users exceed
expectations, not only in terms
of their individual recovery, but
in their subsequent
contributions to services and
their ability to sustain work and
meaningful activity in the
future. The social implications
are phenomenal and cover
numerous areas: pathways back
to work or education become
realistic; appropriate use of
other NHS services provides
substantial financial saving;
problems with housing and
social services can be resolved;
offending behaviour reduced or
stopped; and most importantly
the quality of life for the user
improves dramatically, with newfound
social inclusion and a life
felt to be worth living.”
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