Clinician attitudes towards borderline personality disorder: A 15‐year comparison

Day, Nicholas J. S.; Hunt, Annalise; Cortis-Jones, Louise; Grenyer, Brin F. S.

doi:10.1002/pmh.1429

Cited by 52 publications

(43 citation statements)

References 46 publications

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“…Both positive and negative experiences with mental health professionals and first responders were described by consumers and carers. The literature suggests that stigmatization and discrimination of personality disorder in mental health services continues to be prominent [ 35 ], although professional attitudes toward personality disorder have improved over time [ 36 ]. During crises, consumers and carers expressed receiving better treatment from first responders, compared to mental health professionals, which may mean that mental health professionals have more stigma of personality disorder compared to first responders [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Living with personality disorder and seeking mental health treatment: patients and family members reflect on their experiences

Barr

Jewell²,

Townsend

et al. 2020

bord personal disord emot dysregul

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Background: Despite effective treatments for personality disorders being developed, consumers and carers often report negative experiences of mental health services, including challenges accessing these treatments. Methods: This qualitative study used separate focus groups to compare the unique perspectives of consumer and carers, and to investigate how to improve services for individuals with personality disorders. Reflexive thematic analysis was used to analyze the data. Results: Both consumers and carers (N = 15) discussed the value of providing appropriate information to consumers when they are diagnosed with personality disorder. Consumers and carers described the importance of creating a safe environment for consumers when they present to the emergency department. Both groups discussed experiencing positive and negative treatment from mental health professionals, and suggested that professionals should be trained to understand personality disorder. Limited accessibility and quality of services, and offering peer support to consumers were also described by consumers and carers. Consumers and carers also had perspectives which were unique to their group. Consumers identified the importance of psychological treatment, having a strong therapeutic relationship with a mental health professional, and the benefit of long term psychotherapy with the same professional. Broadening the scope of psychotherapies including creative, animal-assisted, and physical therapies was recommended by consumers. Carers described the importance of assessing for personality disorder and intervening early. Involvement in the assessment, diagnosis, and intervention process was important to carers. The desire to be recognized and supported by mental health professionals was discussed by carers. Conclusions: This research contributes to the concern that consumers with personality disorder and their carers experience stigma and low quality care within mental health services. In line with these findings, we recommend guidelines for health professionals who work with consumers with personality disorder.

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Section: Discussionmentioning

confidence: 99%

Living with personality disorder and seeking mental health treatment: patients and family members reflect on their experiences

Barr

Jewell²,

Townsend

et al. 2020

bord personal disord emot dysregul

View full text Add to dashboard Cite

show abstract

“…Anecdotally, around the time of this study, and with the publication of national and international guidelines [ 25 , 37 ], preference for treatment and management in the community over inpatient hospital admissions was gaining momentum. Hence, it is likely these results reflect a genuine and gradual shift in attitudes about personality disorder at the time of this study [ 38 ]. The greater improvement in the study site suggests the implementation of an intervention including emphasis on stepped care in the community and whole of service development supported and extended this shift in the field.…”

Section: Discussionmentioning

confidence: 99%

Treatment of personality disorder using a whole of service stepped care approach: A cluster randomized controlled trial

et al. 2018

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Background and objectivesPeople with personality disorders are prevalent in emergency and inpatient mental health services. We examined whether implementing a stepped care model of psychological therapy reduces demand on hospital units by people with personality disorder, in a cluster randomized controlled trial.MethodA total of 642 inpatients (average age 36.8, 50.5% female) with a primary ICD-10 personality disorder were recruited during 18 months baseline, then monitored during an 18 month active trial phase. In the active trial phase two equivalent sites were randomised to either treatment as usual (TAU), or a whole of service intervention that diverted people away from hospital and into stepped care psychological therapy clinics. The study design was cost neutral, with no additional staff or resources deployed between sites. A linear mixed models analysis evaluated outcomes.ResultsAs predicted, demand on hospital services reduced significantly in the intervention compared to TAU site. The intervention site evidenced shorter bed days, from an average of 13.46 days at baseline to 4.28 days per admission, and patients were 1.3 times less likely to re-present to the emergency department compared to TAU. Direct cost savings for implementing the approach was estimated at USD$2,720 per patient per year. Limitations included not directly comparing individual symptom changes.ConclusionsUsing a whole of service stepped care model of treatment for personality disorder significantly reduced demand on hospital services.

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“…We also suggest effective training to treat BPD patients. Day, Hunt, Cortis-Jones, and Grenyer (2018) found that healthcare professionals have a better attitude toward BPD patients because there is better affective training for clinicians in the treatment of BPD. Finally, supervision and further research on the therapeutic process and the influence of patients' behaviors on therapists may offer more solutions for the negativity in psychotherapists' responses to patients.…”

Section: )mentioning

confidence: 99%

Psychotherapists’ emotional and physiological reactions toward patients with either borderline personality disorder or depression

Putrino

Casari

Mesurado

et al. 2019

Psychotherapy Research

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Objective: There is a marked difference between the effects of psychotherapy for major depressive disorder (MDD) and borderline personality disorder (BPD), with treatment being less effective for the latter. Considering the importance of the therapeutic relationship in the prognosis of therapeutic results, some of these differential effects might be explained by the distinctive reactions that patients elicit in their therapists. The aim of the present research was to characterize therapists' perceptions of their emotional and physiological reactions to patients diagnosed with MDD or BPD. Method: A semi-structured interview was conducted with 43 clinical psychologists from Argentina with different theoretical orientations. These professionals treated at least one patient diagnosed with BPD and one with MDD during the previous year. Therapists' reactions were categorized through a modified consensual qualitative research analysis. Results: Our findings suggest that psychotherapists feel emotions of dysregulation with BPD patients and sensations of fatigue with MDD patients. Conclusion: The results provide some support for the idea that therapists may mirror their patients' internal experiences. Clinical or methodological significance of this article:The clinical significance is about the psychotherapist´s interoception (body reactions) in the treatment of patients with different disorders such as borderline personality disorder and major depression. The methodology is qualitative because it allows a better approach to access the perceptions and judges from therapists.A therapist's reactions to a patient are typically referred to as countertransference (CT). CT was traditionally conceptualized as unconscious conflicts and defensive reactions toward patients' transference (Hayes et al., 1998). Some authors have suggested that this narrow definition of CT does not adequately define the phenomenon, since therapists have reactions to a number of therapy-related events other than transference, and not all reactions are defensive or unconscious . Hayes (1995) postulated five principal components of CT: origins (the therapist's unresolved psychological conflicts), triggers (patient characteristics or therapy events that provoke the therapist's conflicts), effects (outcomes on therapy), management (the therapist's ability to moderate their reactions) and finally, manifestations (cognitive, emotional, behavioral, and bodily reactions of the therapist). The present study focused on two aspects of CT manifestations: the emotional and physiological reactions of therapists and, in particular, toward two types of patients-those with borderline personality disorder and depression.Several previous studies have reported the presence of therapists' anxiety as a common emotional manifestation of CT (Hayes & Gelso, 1993;Hayes, Nelson, & Fauth, 2015;Hofsess & Tracey, 2010). However, there are fewer studies that focus on other important emotional manifestations of CT. Hayes et al. (1998) conducted a qualitative study analyzing 128 post...

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Clinician attitudes towards borderline personality disorder: A 15‐year comparison

Cited by 52 publications

References 46 publications

Living with personality disorder and seeking mental health treatment: patients and family members reflect on their experiences

Living with personality disorder and seeking mental health treatment: patients and family members reflect on their experiences

Treatment of personality disorder using a whole of service stepped care approach: A cluster randomized controlled trial

Psychotherapists’ emotional and physiological reactions toward patients with either borderline personality disorder or depression

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