Family, Partner and Carer Intervention Manual for Personality Disorders

Families, partners and carers of persons with personality disorder experience significant distress and burden within this role (Bailey & Grenyer, 2013, 2014; Day, Bourke, Townsend, & Grenyer, 2018). Treatment guidelines now recommend supporting families and carers, including involving them in the treatment process to improve wellbeing and thereby assist them in effectively caregiving for the person with personality disorder. This manual has been designed to help services engage and work with families and carers of persons with personality disorder in a brief four session intervention that aims to provide information, support and strategies. This manual has been developed in accordance with the relational model advocated by the Project Air Strategy for Personality Disorders (see The Relational Model of Treatment in the Project Air Strategy Treatment Guidelines). The relational model involves an integrative and collaborative approach to personality disorders treatment, focussing not only on the person with personality disorder but also carers, health services and clinicians. In the relational treatment model, the person’s problems are seen as stemming from problematic and dysfunctional relationship patterns that have developed over time (Grenyer, 2012). These relationship patterns are considered both intrapersonal (how the person relates to themselves, including their feelings and thoughts) and interpersonal (how they relate to others). The relational model recognises that responsibility for effective relationships also rests with others involved in the person’s life. It is now recognised that a service system that works together in an integrated manner better supports people with personality disorders, rather than any sector working in isolation (Grenyer, 2014; Grenyer, Lewis, Fanaian, & Kotze, 2018). Therefore, clinicians, case managers, carers, youth workers, teachers, school counsellors and the broader community share a joint responsibility to respond effectively to the person in a way that is helpful and encouraging (Townsend, Gray, Lancaster, & Grenyer, 2018). Indeed, longitudinal research indicates that clinicians attitudes towards working with individuals with a personality disorder has improved, reflecting the hope and optimism of treatment providers and the wider community informed by over 27 years of evidence and treatment (Day, Hunt, Cortis-Jones, & Grenyer, 2018). Caring for and helping people with personality disorders is everyone\u27s business (Grenyer, Ng, Townsend, & Rao, 2017) and everyone can choose to adopt the key principles from the Project Air Strategy model. This manual was utilized in a randomized controlled trial that sought to provide education and support to carers of individuals with a personality disorder (Grenyer et al., 2018). Compared to waitlist control groups, participants reported improvements in their relationship with their relative with a personality disorder and improvements in family empowerment (reflecting carers ability to take an active role in supporting their relatives treatment). At a 12 month follow-up these improvements were maintained and carers also reported an improvement in their mental health and decreased levels of burden.https://ro.uow.edu.au/uowbooks/1025/thumbnail.jp

A Randomized Controlled Trial of Group Psychoeducation for Carers of Persons With Borderline Personality Disorder

Carers of persons with borderline personality disorder (BPD) experience high burden. Treatment guidelines advocate involving carers in comprehensive therapy approaches. This study is a randomized controlled trial of group psychoeducation, compared to waitlist. Group psychoeducation involved 6-8 carers per group and focused on improving relationship patterns between carers and relatives with BPD, psychoeducation about the disorder, peer support and self-care, and skills to reduce burden. Carers were randomized into intervention (N = 33) or waitlist (N = 35). After 10 weeks, those in the intervention reported improvements in dyadic adjustment with their relative, greater family empowerment, and reduced expressed emotion, sustained after 12 months. There were also improvements in carers\u27 perceptions of being able to play a more active role, such as interacting with service providers. This study demonstrates that providing structured group programs for carers can be an effective way of extending interventions to a group experiencing high burden

Borderline personality or complex Posttraumatic Stress Disorder? An update on the controversy

There remains controversy surrounding the nature of the relationship between borderline personality disorder and posttraumatic stress disorder, with strong arguments that it would be more accurate and less stigmatizing for the former to be considered a trauma spectrum disorder. This article reviews the major criticisms of the DSM-IV diagnosis of borderline personality disorder that have fueled this controversy, including the absence of an etiology for the disorder, which is widely believed to be associated with early traumatic experiences. Also reviewed are recent attempts to redefine the disorder as a trauma spectrum variant based on the apparent overlap in symptomatology, rates of diagnostic comorbidity, and the prevalence of early trauma in individuals with a borderline diagnosis. The conceptual and theoretical problems for these reformulations are discussed, with particular reference to discrepancies in theoretical orientation, confusion of risk with causation, and the different foci of interventions for borderline personality disorder and posttraumatic stress disorder

Archie Brennan, Tapestry Goes Pop!

Join Lisa Mason, National Museums Scotland’s Assistant Curator in Modern and Contemporary Fashion and Textiles, and Kate Grenyer, Exhibitions Curator at Dovecot Studios, for a behind the scenes look at Dovecot’s upcoming exhibition co-curated by National Museums Scotland, Archie Brennan: Tapestry Goes Pop! Enjoy an exclusive preview into the world of a master of modern tapestry and explore pieces that have never before been on public display. Sharp, witty, and immensely talented, Brennan was an innovator and iconoclast who inspired weavers all over the world. Learn more about how his work sits alongside other artists in the national collection and how his legacy continues to influence the world of tapestry

Prevalence, prediction, and prevention of psychologist misconduct

Studies of psychologist misconduct generally focus on unethical sexual behaviours. In contrast, the following study reports on all complaints by the public against psychologists reported to the New South Wales Psychologis ts Registration Board over a 4-year period. There were 248 independent notifications of misconduct about 224 registered psychologists, out of a total sample of 9,489 registered psychologists_ The most frequent type of misconduct reported was in relation to poor communica tion standards (35.5%). Other complaints were in relation to professional Incompetency (16.5%), poor report writing (14.1%), poor business practices (12.5%)\u27 boundary violations (9.7%), poor cha racter (5.6%), registration status (3.2%), impairment (1.6%), and the inapp ropriate use of specialist titles (1.2%1. Males were 2.5 times more likely to have a misconduct complaint made about them than females. Sen ior highly qualified psychologists att racted a greater number of complaints, but these were generally of a less serious nature, Over a 30-year career, about 20 out of every 100 psychologists can expect to receive a complaint from the public, and two will receive a serious misconduct complaint that might lead to deregistration, Strategies for preventing malpractice arising from these results include regular peer consultation, developing quality practise standards, and mamtaining professional boundaries

Treatment of personality disorder using a whole of service stepped care approach: A cluster randomized controlled trial

Background and objectives People with personality disorders are prevalent in emergency and inpatient mental health services. We examined whether implementing a stepped care model of psychological therapy reduces demand on hospital units by people with personality disorder, in a cluster randomized controlled trial. Method A total of 642 inpatients (average age 36.8, 50.5% female) with a primary ICD-10 personality disorder were recruited during 18 months baseline, then monitored during an 18 month active trial phase. In the active trial phase two equivalent sites were randomised to either treatment as usual (TAU), or a whole of service intervention that diverted people away from hospital and into stepped care psychological therapy clinics. The study design was cost neutral, with no additional staff or resources deployed between sites. A linear mixed models analysis evaluated outcomes. Results As predicted, demand on hospital services reduced significantly in the intervention compared to TAU site. The intervention site evidenced shorter bed days, from an average of 13.46 days at baseline to 4.28 days per admission, and patients were 1.3 times less likely to re-present to the emergency department compared to TAU. Direct cost savings for implementing the approach was estimated at USD$2,720 per patient per year. Limitations included not directly comparing individual symptom changes. Conclusions Using a whole of service stepped care model of treatment for personality disorder significantly reduced demand on hospital services

Mental health presentations to acute psychiatric services: 3-year study of prevalence and readmission risk for personality disorders compared with psychotic, affective, substance or other disorders

Background The relative burden and risk of readmission for people with personality disorders in hospital settings is unknown. Aims To compare hospital use of people with personality disorder with that of people with other mental health diagnoses, such as psychoses and affective disorders. Method Naturalistic study of hospital presentations for mental health in a large community catchment. Mixed-effects Cox regression and survival curves were generated to examine risk of readmission for each group. Results Of 2894 people presenting to hospital, patients with personality disorder represented 20.5% of emergency and 26.6% of in-patients. Patients with personality disorder or psychoses were 2.3 times (95% CI 1.79-2.99) more likely than others to re-present within 28 days. Personality disorder diagnosis increases rate of readmission by a factor of 8.7 (s.e. = 0.31), marginally lower than psychotic disorders (10.02, s.e. = 0.31). Conclusions Personality disorders place significant demands on in-patient and emergency departments, similar to that of psychoses in terms of presentation and risk of readmission

Improving services for people with personality disorders: views of experienced clinicians

People with personality disorders are frequent users of both inpatient and outpatient psychiatric services, representing a significantly large proportion of all mental health clients. Despite this, most services find it a challenge to offer the most appropriate and effective treatment models for people with personality disorders. This paper is a report of a study of clinician opinions about how organizations can improve the delivery of services to people with personality disorders. Data was collected from experienced clinicians attending a personality disorders clinical and scientific meeting who were asked to work together in groups and present solutions for how organizations can improve the services provided to people with personality disorders. Qualitative data was collected and thematically and semantically analyzed using Nvivo and Leximancer. The Nvivo analysis revealed five main areas in which clinicians believe organizations can improve services for people with personality disorders. These focused on: (i) more training and education for health professionals and carers; (ii) better support through supervision and leadership; (iii) adoption of a more consistent evidence-based approach to client management and treatment; (iv) clearer guidelines and protocols; and (v) changed attitudes about personality disorder to decrease stigma. The Leximancer analysis of responses indicated the identified themes were not distinct; rather they were interconnected and related to one another, semantically. In summary, clinicians across a large and diverse geographical area developed a consensus that mainstream management of personality disorder is largely poor and inadequate. The findings lend support to an integrative and collaborative whole-service approach that enhances evidence-based practice in the community