Personality disorder, primary care counselling and therapeutic effectiveness

Abstract

An evaluation of a primary care counselling service was conducted. Measures completed by clients were the CORE questionnaire (assessing subjective well-being, symptoms, functioning and risk) and the DIS(BI) (Swartz et al., 1990) identifying cluster B personality disorders. Counsellors' written accounts of the benefits gained in therapy by their clients were also collected. At assessment, it was found that mean scores on the CORE questionnaire suggested the client group was experiencing similar levels of distress as those who attend other psychotherapy services; 50% of clients satisfied the DIS(BI) criterion for cluster B personality disorder. After therapy, there was a significant decrease in scores on all the subscales of the CORE questionnaire. Although those who scored above the criterion on the DIS(BI) indicating a personality disorder had significantly worse scores on the CORE at both pre and post therapy, as a group they nonetheless gained significant benefits from the counselling service. A content analysis method was utilised, based on previous thematic analyses of experiential therapies, to explore the counsellors' perceptions of the benefits of counselling for their clients. Counsellors perceived their clients as having changed in their experience of themselves or of their relationships and to have benefited from a safe, validating and supportive relationship. These benefits therefore relate to person-centred theory in which the counsellors were trained.

Personality Disorder in Primary Care: Factors Associated with Therapist Views of Process and Outcome

“…There have been few studies to date that have investigated PD in primary care medical and mental health participants. This study focused on a sample of the latter group referred for psychological treatment, confirming previous reports of the high frequency of PD presentations to non-specialist services (Howey and Ormrod, 2002). Rates of PD were also similar to those of 30-60% comorbidity in larger US samples (Brown and Barlow, 1992;Shea, Widiger and Klein, 1992).…”

“…In primary health care, Moran found 24% of patients met criteria for PD according to informant interviews (Moran, Jenkins, Tylee, Blizard and Mann, 2000). Moreover, Howey and Ormrod reported 50% of primary care counselling patients met PD criteria on a self-report measure (Howey and Ormrod, 2002), whilst a report from the UK Department of Health for 2000-2001 noted 76,300 referrals to Clinical Psychology Departments in England (DoH, 2001). These figures indicate that the vast majority of people with PD will not be seen by specialist PD services.…”

Establishing how psychological therapies work: the importance of mediation analysis

“…These included enhancement of interpersonal functioning and teaching self-monitoring to allow early selfintervention during relapses (Miklowitz & Scott, 2009). Such processes have also been implicated in interpersonal therapy (IPT) (Lipsitz & Markowitz, 2013) and can be seen to be present in other therapies such as CBT (Livesley, 2007;Steever, 1999), MBT (Epstein et al, 2008) and counselling (Howey & Ormrod, 2002). It was particularly noteworthy that effective therapies shared a number of common characteristics with regards to how the model of therapy was shared with the patient, how the therapy was delivered and the structuring of treatment (Miklowitz & Scott, 2009).…”

Evaluating a primary care counselling service: outcomes and issues

“…Evidence from RCTs has, however, been criticized because the level of control required in the design of RCTs makes them unrepresentative of everyday practice (Hemmings, 2000;Mellor-Clark, 2000b;2000c;Howey and Ormrod, 2002). In this respect Hemmings (2000) draws a distinction between efficacy and effectiveness research.…”

“…Hemmings (2000), who lists further limitations of RCTs for evaluating counselling, reviewed effectiveness studies of counselling as delivered in naturalistic, everyday practice and found improved psychological well-being measured across a range of measures. A number of studies evaluating counselling in primary care contexts have reported improvements in patient well-being (Baker et al, 1998;Nettleton et al, 2000;Howey and Ormrod, 2002), often maintained in the long term (two years' follow-up) (Gordon and Wedge, 1998;Baker et al, 2002).…”