This doctoral thesis explores paradigms currently used in mental health services. The thesis comprises a literature review, a research paper and a critical appraisal. A final section is dedicated to the ethical procedures undertaken prior to undertaking the research. The literature review is a systematic review which synthesises 14 qualitative papers studying the experiences of accessing mental health services for individuals who have received a diagnosis of borderline personality disorder. The overarching theme ‘bpd is a double-edged sword’ is labelled along with four sub-themes: ‘undeserving of care’, ‘disempowerment’, ‘safety and containment’ and ‘approaching recovery’. Findings suggest the need for further inclusion of service users in the development of service provision and an approach that is formulation-based and grounded in attachment theory. The research paper explores psychiatrists’ understanding and use of psychological formulation. A constructivist grounded theory framework led to an initial conceptualisation and model. Four conceptual categories were named as ‘conceptualising formulation’, ‘singing off the same hymn sheet’, ‘barriers to formulation’ and ‘making a Frankenstein’s monster’. In particular the findings suggest that psychiatrists view and use psychological formulation in a different way from that outlined by clinical psychologists and that there are multiple barriers to its use. Finally, the critical review presents challenges encountered during the research project and personal reflections on the process. Overall the thesis highlights the need for mental health services to embrace multiple paradigms and remain open to alternative discourses around mental illness in order to provide a holistic and integrated service provision. A formulation-based approach may provide such an arena, while allowing space for individualised care. Clinical psychologists are well placed to promote such an approach via service development and consultation with multidisciplinary staff
