Engagement and early termination of contact with a community‐based early intervention service for personality disorder in young adults

Farrand, Paul; Booth, Nicholas J.; Gilbert, Tony; Lankshear, Gloria

doi:10.1111/j.1751-7893.2009.00134.x

Cited by 5 publications

(3 citation statements)

References 40 publications

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“…These challenging behaviors, called therapy-interfering behaviors (TIBs) by Linehan (1993), have been defined as client or therapist behaviors that interfere with the client receiving or benefiting from the therapy offered. Clients with BPD tend to engage in multiple challenging behaviors that interfere with receiving therapy, such as calling the therapist at unreasonable hours outside of session (Dimeff & Linehan, 2001), behaving ineffectively on phone calls (Linehan, 2008), being non-collaborative (e.g., arguing with the therapist), and quitting therapy (Bados, Balaguer, & Saldaña, 2007; Espinosa, Grynberg, & Mendoza, 2009; Farrand, Booth, Gilbert, & Lankshear, 2009; Oumaya et al, 2010). This, paired with emotional and behavioral dyscontrol, including suicidal and non-suicidal self-directed violence (SDV), results in these individuals being difficult-to-treat, BPD being a highly stigmatized disorder, and trepidation by clinicians to provide treatment for clients with BPD (Gunderson et al, 2011; Linehan, Cochran, Mar, Levensky, & Comtois, 2000; Paris, 2005).…”

Section: Introductionmentioning

confidence: 99%

Examining challenging behaviors of clients with borderline personality disorder

Chalker

Carmel

Atkins

et al. 2015

Behaviour Research and Therapy

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Few studies have examined effects of challenging behaviors of clients with borderline personality disorder (BPD) on psychotherapy outcomes. Dialectical behavior therapy (DBT) is an evidence-based treatment designed to treat chronic suicidality, self-directed violence (SDV), and emotion dysregulation, while targeting challenging behaviors. DBT has been shown to be effective with clients with BPD. We evaluated whether therapist reported challenging behaviors, such as high volume phone contacts or violating the therapist’s limits, during DBT would be associated with dropping out of DBT, severity and frequency of SDV, emotion regulation deficits, and client’s and therapist’s satisfaction of treatment. The current study examined challenging behaviors reported by therapists in a sample of 63 psychiatrically disabled outpatient DBT clients diagnosed with BPD (73% women, average age 37 years). More frequent phone contacts were associated with a decrease in dropout and psychological symptoms, and an increase in client and therapist satisfaction. More avoidance/disengagement behavior was associated with more than twice the risk of SDV and a decrease in therapist satisfaction. Findings suggest that the phone coaching might serve to maximize client satisfaction and reduce the likelihood of dropout.

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Section: Introductionmentioning

confidence: 99%

Examining challenging behaviors of clients with borderline personality disorder

Chalker

Carmel

Atkins

et al. 2015

Behaviour Research and Therapy

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“…Differences were observed between this group and those who dropped out early (before 5 months on caseload) and included a tendency for the former to have left school before the end of the final year, express a greater number of difficulties and live in more deprived areas. In contrast, the latter tended to be better educated and have problems in more categories, especially mental health and substance use (28).…”

Section: Methodsmentioning

confidence: 99%

Troubled lives: chaos and trauma in the accounts of young people considered ‘at risk’ of diagnosis of personality disorder

Gilbert

Farrand

Lankshear

2012

Scandinavian Caring Sciences

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This study explores accounts provided by 27 young people who had contact with an early intervention service for young people considered to be 'at risk' of diagnosis of personality disorder. These accounts, developed from semi-structured interviews, focussed on their experiences prior to and since referral, which normally followed an episode of extremely risky behaviour such as self-harm or a suicide attempt. Analysis provided three themes. These focussed on the chaotic lifestyles of the young people, which were punctuated by episodes of self-harm and other risky behaviours; the unsupportive or traumatic relationships with parents and partners, which culminated in a toxic mix of isolation and self-blame and the role of case coordinators. The lack of stable adult relationships is evident. Findings suggest the establishment of stable, supportive adult relationships with a view to providing a problem-solving approach with the aim of guiding young people away from risky acts and their traumatic consequences may be fruitful. The challenge is to find a sustainable way of establishing such a model outside of paid relationships. The other challenge is to develop research approaches with similarly placed young people, which enable ongoing contact.

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“…Regardless of the point of entry, youths in the juvenile justice system often display an array of mental health problems, many masked by unlawful activity and problem behaviors. Family-based and multisystemic treatments have been used successfully with court-involved adolescents (Henggeler & Sheidow, 2012), although continued research is needed to understand the challenges that emerge when treating adolescents and young adults presenting with both substance use disorders and severe co-occurring psychiatric disorders or personality disorders (Farrand, Booth, Gilbert, & Lankshear, 2009).…”

mentioning

confidence: 99%

The efficacy of two adolescent substance abuse treatments and the impact of comorbid depression: Results of a small randomized controlled trial.

Santisteban¹,

Mena²,

Muir³

et al. 2015

Psychiatric Rehabilitation Journal

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Objective The purpose of this randomized trial was to investigate the efficacy of two behavioral treatments focusing on different change mechanisms in ameliorating a borderline personality disorder constellation of behaviors and substance use in adolescents referred by juvenile diversion programs. Methods Forty adolescents 14 to 17 years of age and meeting DSM IV criteria for borderline personality disorder and substance use disorders were randomized to Integrative Borderline Personality Disorder-Oriented Adolescent Family Therapy (I-BAFT) or Individual Drug Counseling (IDC). This design allowed a comparison of two manualized interventions, one family-based and one individually-oriented. Profiles of clinical change were used to detect impact and to estimate treatment effect sizes. Results Primary analyses showed that both interventions had a clinically significant impact on borderline personality disorder behaviors 12 months after baseline but with no differential treatment effects. The impact on substance use was more complex. Subgroup analyses revealed that adolescents with depression had significantly more severe profiles of borderline personality disorder and substance use. These youth were the only group to show reductions in substance use, but only if they received the I-BAFT intervention. Study data also documented the high dosage of intensive residential treatment needed by this population. Conclusions and Implications for Practice Results highlight the intensive treatment needs of juvenile justice involved youth with co-occurring substance use and borderline personality disorder including depression, the hybrid outpatient and residential treatment often required by this population, and the promise of a family oriented approach particularly for youth with severe symptoms and co-occurring depression.

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Engagement and early termination of contact with a community‐based early intervention service for personality disorder in young adults

Cited by 5 publications

References 40 publications

Examining challenging behaviors of clients with borderline personality disorder

Examining challenging behaviors of clients with borderline personality disorder

Troubled lives: chaos and trauma in the accounts of young people considered ‘at risk’ of diagnosis of personality disorder

The efficacy of two adolescent substance abuse treatments and the impact of comorbid depression: Results of a small randomized controlled trial.

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