‘There's always this sense of failure’: an interpretative phenomenological analysis of primary care counsellors' experiences of working with the borderline client

Rizq, Rosemary

doi:10.1080/02650533.2011.579695

Cited by 11 publications

(12 citation statements)

References 34 publications

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“…Good team-working and sharing responsibilities for treatment and decisions regarding safety also helped clinicians to feel supported. This appeared to be reported most often regarding specialist teams, especially in those using DBT and CAT models, and in therapeutic communities, and least frequently in primary care settings – where “you’re kind of left on your own with somebody” (63) . There could also be challenges in teams where only one or two clinicians in a team were trained in a particular therapeutic intervention or skill set.…”

Section: Resultsmentioning

confidence: 99%

Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Troup

Lever-Taylor

et al. 2020

Preprint

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Introduction The need to improve the quality of community mental health services for people with Complex Emotional Needs (CEN) is recognised internationally and has become a renewed policy priority in England. Such improvement requires positive engagement from clinicians across the service system, and their perspectives on achieving good practice need to be understood. Aim To synthesise qualitative evidence on clinician perspectives on what constitutes good practice, and what helps or prevents it being achieved, in community mental health services for people with CEN. Methods Six bibliographic databases were searched for studies published since 2003 and supplementary citation tracking was conducted. Studies that used any recognised qualitative method and reported clinician experiences and perspectives on community-based mental health services for adults with CEN were eligible for this review, including generic and specialist settings. Meta-synthesis was used to generate and synthesise over-arching themes across included studies. Results Twenty-nine papers were eligible for inclusion. Six over-arching themes were identified: 1. The use and misuse of diagnosis; 2. The patient journey into services: nowhere to go; 3. Therapeutic relationships: connection and distance; 4. The nature of treatment: not doing too much or too little; 5. Managing safety issues and crises: being measured and proactive; 6. Clinician and wider service needs: whose needs are they anyway? The overall quality of the evidence was moderate. Discussion Through summarising the literature on clinician perspectives on good practice for people with CEN, over-arching priorities were identified on which there appears to be substantial consensus. In their focus on needs such as for a long-term perspective on treatment journeys, high quality and consistent therapeutic relationships, and a balanced approach to safety, clinician priorities are mainly congruent with those found in studies on service user views. They also identify clinician needs that should be met for good care to be provided, including for supervision, joint working and organisational support.

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Section: Resultsmentioning

confidence: 99%

Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Troup

Lever-Taylor

et al. 2020

Preprint

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“…Professionals viewed crisis as an ongoing issue for PdxBPD (Commons Treloar, 2009; Nehls, 2000; Rizq, 2012; Rogers & Acton, 2012), and a quantitative study ( n = 27) found a few PdxBPD comprising the majority of referrals (13 = 78%, 5 = 53%) to an intensive home treatment team (IHTT) (Turhan & Taylor, 2016). Through focus groups ( n = 9), professionals described hospital admissions as recurrent “back, forth” admission cycles, adding that admission for one person lasted “3 or 4 years” (Warrender, 2015).…”

Section: Methodsmentioning

confidence: 99%

“…Qualitative studies found they could relieve or add to suffering (Perseius et al., 2005) ( n = 10) as PdxBPD experienced both helpful and discriminatory experiences (Veysey, 2014) ( n = 8). Through interviews, professionals ( n = 5) perceived that PdxBPD have high expectations of them and are sensitive to interpersonal disappointment due to adverse childhood experiences, further considering therapeutic relationships potentially re‐traumatizing patients when ending (Rizq, 2012). Professionals perceived PdxBPD’s difficulties with them as a parallel process and a repetition of experiences outside of care, though also valuable opportunities for learning (Bowen, 2013).…”

Section: Methodsmentioning

confidence: 99%

“…Uncertainty emerged regarding who should hold responsibility for PdxBPD. Three qualitative studies using interviews found professionals felt responsibility for the safety of PdxBPD (Rizq, 2012) and sometimes felt this was transferred to them by patients (Hughes et al., 2017; Nehls, 2000). However, some PdxBPD countered that suicidality could actually be through their desire to take responsibility for themselves (Holm & Severinsson, 2011).…”

Section: Methodsmentioning

confidence: 99%

“…Professionals struggled with suicide risk and felt uncertain whether intervention was required or not (Rizq, 2012). Nehls’ (2000) interviews with professionals ( n = 17) described this as balancing over‐ and under‐concern.…”

Section: Methodsmentioning

confidence: 99%

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Perspectives of crisis intervention for people diagnosed with “borderline personality disorder”: An integrative review

Warrender

Bain

Murray

et al. 2020

Psychiatric Ment Health Nurs

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Accessible Summary What is known on the subject? People diagnosed with “BPD” often experience crisis and use services “BPD” is a controversial diagnosis, and the experience of crisis and crisis intervention is not well understood What this paper adds to existing knowledge? People diagnosed with “BPD” have different experiences of crisis, and using the diagnosis alone as a basis for deciding care and treatment is not appropriate There are many human factors which can influence how professionals deliver care to people diagnosed with “BPD” What are the implications for practice? The education of staff, views on responsibility, team conflicts and access to clinical supervision can have an impact on how care is delivered, and should be addressed by organizations providing crisis care. Access to care often occurs when a person is self‐harming or suicidal, but does not address underlying distress. Crisis care should go beyond managing behaviour and address any underlying needs. Abstract Introduction“Borderline personality disorder” (“BPD”) is associated with frequent use of crisis intervention services. However, no robust evidence base supports specific interventions, and people's experiences are not well understood. AimTo explore the experiences of stakeholders involved in the crisis care of people diagnosed with “BPD.” MethodIntegrative review with nine databases searched January 2000 to November 2017. The search filtered 3,169 titles and abstracts with 46 full‐text articles appraised and included. ResultsFour themes were constructed from thematic analysis: crisis as a recurrent multidimensional cycle, variations and dynamics impacting on crisis intervention, impact of interpersonal dynamics and communication on crisis, and balancing decision‐making and responsibility in managing crisis. DiscussionCrisis is a multidimensional subjective experience, which also contributes to distress for family carers and professionals. Crisis interventions had limited and subjective benefit. They are influenced by accessibility of services, different understandings of “BPD” and human dynamics in complex decision‐making, and can be experienced as helpful or harmful. Implications for practiceSubjectivity of crisis experiences shows limitations of the diagnostic model of “BPD,” emphasizing that interventions should remain person‐centred. While thresholds for intervention are often met after self‐harm or suicidality, professionals should review approaches to care and support people with underlying distress.

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‘I Just Don't Agree’: A Voice-Oriented Analysis of An IFPS Case of Alleged Child Maltreatment

Puyenbroeck

Loots

Grietens³

et al. 2013

Journal of Social Work Practice

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‘There's always this sense of failure’: an interpretative phenomenological analysis of primary care counsellors' experiences of working with the borderline client

Cited by 11 publications

References 34 publications

Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Perspectives of crisis intervention for people diagnosed with “borderline personality disorder”: An integrative review

‘I Just Don't Agree’: A Voice-Oriented Analysis of An IFPS Case of Alleged Child Maltreatment

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