The effects of diagnosis and non‐compliance attributions on therapeutic alliance processes in adult acute psychiatric settings

Abstract

To investigate the effects of the diagnoses of borderline personality disorder (BPD) and major depressive disorder (MDD), together with reasons for client non-compliance with therapy tasks, on mental health workers' helping, empathy and anger reactions. Utilizing a 2 x 2 x 2 factorial design, mental health nurses were asked to read a series of vignettes and complete a 15-item rating scale for helping, empathy and anger reactions to each of the vignettes. Eight clinical vignettes were constructed and contained a combination of controllable/uncontrollable and stable/unstable attributional dimensions for service users who failed to complete a therapy task. The diagnoses of BPD and MDD were added to the vignettes to determine whether diagnoses affected alliance factors. A total of 26 mental health workers participated in the study and there were main effects for those workers to be angrier when causes were perceived as due to controllable factors; to be more helpful to service users' with a diagnosis of MDD; and less helpful when causes were perceived to be due to stable factors. Results show some support for Weiner's model of helping behaviour. It is suggested that there is an important role to explore the attributions of mental health workers working with service users with BPD. A role for case conceptualization is discussed to facilitate therapeutic engagement with service users with a diagnosis of BPD.

Exploring Registered Psychiatric Nurses' Responses towards Service Users with a Diagnosis of Borderline Personality Disorder

“…In contrast, nurses are more likely to respond with sad and self-critical feelings towards psychotic service users and with warm and helpful feelings towards those with neurosis [16]. Other findings suggest that nurses may perceive service users with a BPD to have a greater degree of control over the negative behaviours they display, when compared to those with other disorders [12, 14]. …”

Evaluation of awareness level knowledge and understanding framework personality disorder training with mental health staff: impact on attitudes and clinical practice

“…Nursing staff may respond more negatively to people with BPD than other disorders, e.g. schizophrenia and depression (Markham & Trower, 2003;Forsyth 2007;Westwood & Baker, 2010), and may also be less optimistic about the potential of people with BPD to recover (Markham & Trower 2003), viewing them as more difficult to care for compared to other service users (James & Cowman, 2007;Howes, Weaver, & Tyrer, 2008). Woollaston & Hixenbaugh, 2008 found that some nursing staff felt they lacked the necessary skills to work with people with BPD, but wanted to improve their practice with this service user group.…”

Staff attitudes towards inpatients with borderline personality disorder

“…A suggested reason for this is that these clients are seen as healthier than other patients, therefore when they display challenging behaviours such as self harm or anger, nurses become less empathetic and withdraw (Fraser and Gallop 1993). Further research supports this theory by proposing that BPD patients have greater control over their behaviours than patients with other diagnoses, with the result that any negative behaviour is seen as deliberate (Markham and Trower 2003;Forsyth 2007). Markham and Trower's (2003) study was limited because participants were aware they were being asked about attitudes to different groups of patients so may have changed their answers accordingly (Westwood and Baker 2010), but these findings do resonate with the literature around this topic.…”