Processes of recovery from Borderline Personality Disorder (BPD): A qualitative study

The processes facilitating recovery in Borderline Personality Disorder (BPD) are poorly understood. This thesis aimed to explore how recovery is reached, focusing on service users’ perspectives. Part 1 is a qualitative meta-synthesis of findings from 14 qualitative studies exploring service users’ experiences of their treatment for BPD and their recovery journey. The findings highlighted areas of improvement that were important for service users, including developing self-acceptance and self-confidence, controlling difficult thoughts and emotions, practising new ways of relating to others, and making practical achievements. However, it was unclear how change in these areas was achieved. Part 2 is a qualitative study exploring how recovery in BPD is reached through routine or specialist treatment, as perceived mainly by service users, but also by therapists and relatives. Three central processes that constituted service users' recovery journey were identified: fighting ambivalence and committing to taking action; moving from shame to self-acceptance and compassion; and moving from distrust and defensiveness to opening up to others. Four therapeutic challenges needed to be successfully addressed to support this journey: balancing self exploration and finding solutions; balancing structure and flexibility; encouraging service users to confront interpersonal difficulties and practise new ways of relating; and balancing support and independence. Part 3 is a critical appraisal of the challenges encountered in the research process and the ways in which these were addressed. The concept of reflexivity was used as a framework for considering the main issues

Why do some voluntary patients feel coerced into hospitalisation? A mixed-methods study

This study aimed to investigate factors linked to perceived coercion at admission and during treatment among voluntary inpatients. Quantitative and qualitative methods were used. Two hundred seventy patients were screened for perceived coercion at admission. Those who felt coerced into admission rated their perceived coercion during treatment a month after admission. Patient characteristics and experiences were tested as predictors of coercion. In-depth interviews on experiences leading to perceived coercion were conducted with 36 participants and analysed thematically. Thirty-four percent of patients felt coerced into admission and half of those still felt coerced a month later. No patient characteristics were associated with perceived coercion. Those whose satisfaction with treatment increased more markedly between baseline and a month later were less likely to feel coerced a month after admission. In the qualitative interviews three themes leading to perceived coercion were identified: viewing the hospital as ineffective and other treatments as more appropriate, not participating in the admission and treatment and not feeling respected. Involving patients in the decision-making and treating them with respect may reduce perceived coercion

Association of treatment satisfaction and psychopathological sub-syndromes among involuntary patients with psychotic disorders

Publisher's version: http://www.springerlink.com/content/rx24036274667t10

Clients’ experiences of treatment and recovery in Borderline Personality Disorder (BPD): a meta-synthesis of qualitative studies

OBJECTIVE: This review synthesized findings from qualitative studies exploring clients’ experiences of their treatment for borderline personality disorder (BPD) and their perceptions of recovery. METHOD: Fourteen studies were identified through searches in three electronic databases. The Critical Appraisal Skills Programme was used to appraise the methodological quality of the studies. Thematic analysis was used to synthesize the findings. RESULTS: The meta-synthesis identified 10 themes, grouped into 3 domains. The first domain, “Areas of change,” suggests that clients make changes in four main areas: developing self-acceptance and self-confidence; controlling difficult thoughts and emotions; practising new ways of relating to others; and implementing practical changes and developing hope. The second domain, “Helpful and unhelpful treatment characteristics,” highlights treatment elements that either supported or hindered recovery: safety and containment; being cared for and respected; not being an equal partner in treatment; and focusing on change. The third domain, “The nature of change,” refers to clients’ experience of change as an open-ended journey and a series of achievements and setbacks. CONCLUSIONS: The meta-synthesis highlights areas of change experienced by individuals receiving treatment for BPD, and treatment characteristics that they value. However, further research is needed to better understand how these changes are achieved

Coerced Hospital Admission and Symptom Change-A Prospective Observational Multi-Centre Study

PMCID: PMC3227658 Freely available online via CCplosone.org