Exploring staff perceptions of the utility of clinician connections when working with emotionally dysregulated clients

Abstract

Background Borderline personality disorder (BPD) is considered to be a challenging condition for clinicians to treat. Clinicians routinely working with individuals who experience severe emotional dysregulation often do not receive appropriate training and support to work with this client group. This article describes an intervention, Clinician Connections (CC), which was developed to support practitioners who work with individuals with BPD. CC aims to increase practitioner’s knowledge of BPD, develop a skillset to work with emotionally dysregulated individuals and enhance practitioner’s self-efficacy with regard to working effectively with this client group. The aim of this study is to investigate the perceived utility and acceptability of CC, and identify areas for further development of the intervention. Method A seven-hour CC workshop was provided to Emergency Department and community mental health clinicians. Three focus groups were completed following completion of the intervention with 13 clinicians (12 female; 1 male) and were audio recorded. The study utilised a thematic analysis framework. Results Six master themes emerged from the focus group data which included 10 subordinate themes. The master themes identified were: the need for training; a new understanding; validation; barriers to applying new skills; overcoming barriers to skill application; and future direction: practical application of skills. Participants reflected on how their new understanding of transactions and their own experiences affects their practice. They also noted improved client interactions and client relationships resulting from the use of validation. While there was an increase in participants’ self-efficacy in working with individuals with BPD, a need for further skills and practice was also highlighted. Conclusion The evidence presented here suggests that CC is both beneficial and feasible. Qualitative feedback suggests there is a need for further support in the strengthening and generalisation of skills. Suggestions were made by practitioners regarding potential improvements to the delivery of the workshop. Future research could evaluate the changes made to CC and focus on a quantitative approach to quantify the impact of CC.

Impact on staff attitudes of brief personality disorder training for acute psychiatric wards

“…Implementing targeted training can be an effective way to improve understanding, optimism and confidence, as well as improving staff attitudes towards service users with a diagnosis of “personality disorder” (Clarke et al , 2015; Darongkamas et al , 2020; Ebrahim et al , 2016; Lamph et al , 2014; Woodward et al , 2009). Training that is targeted at structuring the environments of service users diagnosed with “personality disorder” has been found to help staff develop a skillset for working effectively with service users who have difficulties in recognising and regulating emotions, through reflective practice, peer support and decreasing their levels of work-related stress (Burke et al , 2019). In a qualitative study of experts by experience in receiving a “personality disorder” diagnosis and accessing mental health services in community and forensic settings, service users believed that improved staff understanding and attitudes can support and facilitate recovery (Shepherd et al , 2017).…”

Use of Acute Psychiatric Hospitalisation: A Study of the Factors Influencing Decisions to Arrange Acute Admission to Inpatient Mental Health Facilities

“…Running across all four themes was the particular relevance of personality disorder to decision-making. In line with previous studies (25)(26)(27), the clinical assessment of patients with personality disorder (as opposed to those with mental illness) was considered more challenging. This study suggests tensions, negative attitudes and possibly a negative bias of staff toward this patient population.…”

Experiences of crisis care among service users with complex emotional needs or a diagnosis of 'personality disorder', and other stakeholders: systematic review and meta-synthesis of the qualitative literature

“…Of the included studies, three were conducted in the UK, 9,21,22 two were from Canada, 6,23 one study each was conducted in Australia, 24 the USA, 3 Sweden, 25 Ireland, 26 and The Netherlands, 10 and one study was conducted across Australia and New Zealand. 27 Sample sizes ranged from six to 500 participants (the study that used 500 participants performed content analysis 3 ).…”

“…Study settings included emergency departments and international equivalents, 6,23,26,27 brief admission units 10,25 and a personality disorder resource center, 3 which was a central point of contact in a USA district that connected service users to appropriate mental health services, including crisis services. There were no studies exploring experiences of crisis teams or other community options for crisis care, such as crisis cafes, acute day units or crisis houses.…”

“…Only one paper included a service user population with confirmed diagnoses of personality disorder other than borderline personality disorder: this included participants with a diagnosis of antisocial personality disorder. 23 One study looked at staff perspectives, 26 which included A&E staff and community mental health clinicians. Two papers focused on family carers.…”