Personality Disorder Training;
what is the point?
Andy Williams, Consultant Psychiatrist in Psychotherapy
Sue Wallace, Sen. Adult Psychotherapist, Mandy Carruth, Nurse Therapist
Personality Disorder and Homelessness Team
NHS Greater Glasgow and Clyde
Background
• Almost 8 years experience of PD
training in homeless services in Glasgow
• Recent experience of training in prisons
• What have we learned about how to do
it?
• What level of training is right?
• What style of training is right?
PD and Homelessness Team
the context
Psychodynamic psychotherapy – MBT
Small resource
City-wide
Remit to work across agencies
Emphasis on consultation and TRAINING
PD and Homelessness Team
Expectations of what training could achieve
• Reduce repeat homelessness !
• Give staff
Tools
Strategies
to manage/ cope with difficult behaviour
What are requests for training
about?
interest to know
more about the
subject
feeling of being
overwhelmed by
the work
stress/ anxiety
in the
organisation
not knowing how
best to support
someone
someone else
might know what
to do – an
expert?
What are requests for training
about?
feeling of being
overwhelmed by
the work
interest to know
more about the
subject
“My manager
told me to
come”
not knowing how
best to support
someone
someone else
might know what
to do – an
expert?
stress/ anxiety
in the
organisation
What are we trying to achieve?
Change in:
knowledge
skills
attitud
e
practice makes perfect…
• 2006 – 2014
• 8-10 training days/ year
• Total of 1,331 staff trained
in the beginning……
reflective
practice
Can people think more about what is going
on for the person with personality
disorder?
transference and
countertransference
and for themselves,
and their teams?
splitting
genes
temperament
Can people keep in mind the possible
origins of “difficult” behaviour?
and think about development/
early attachment
attachment
curiosity
Can people shift to a more empathic
position?
empathy
Draw a picture
Elements in the 1 day
Introduction to PD training
• A lot about attachment and the relationship
• A fair bit of thinking about scenarios
• A wee bit on definitions and categories of
personality disorder
•
•
•
•
Group work
Controversies
Complexity
Discussion
Could we adapt this for prison
settings?
• Thanks to:
Dr Alex Quinn, Cons Forensic Psychiatrist NHS Lothian
Dr Jo Brown, SpR in Forensic Psychiatry, NHS Lothian
Personality Disorder Training for SPS and
prison healthcare staff
• 10 training days over a 6 month period from Jan to
June 2014
• Barlinnie 4 days
• Greenock 2 days
• Low Moss 4 days
• Total of 186 staff
Write on a picture
What was different?
•
•
•
•
more time on antisocial/ psychopathy
paranoid and schizoid also included
more forensic cases/ issues discussed
more about criminality and
responsibility
humility
humour
More time on Empathy and distinguishing
from Collusion
• Can empathise without agreeing
• Not the same as taking side of prisoner
• Discuss concerns about “looking soft” in
front of colleagues
• Concerns about being “taken in”
Managing BPD
Key Approaches
Empathic
Cold/
hostile
consistent
inconsistent
boundaried
Unboundaried
some graphs….
Question 1:
How well did the learning event meet your aims/
objectives?
Question 2:
How relevant was the content of the event to your
work?
Question 3:
Please rate the presentation of information
Question 4:
Suitability of audio/visual aids (eg slides, video)
Question 5:
Suitability of venue
140
120
100
Q1
Q2
Q3
Q4
Q5
80
60
40
20
0
Very
poor
Poor Average Good
Very
good
How much of the event did you find
interesting?
All of it
Some of it
None of it
161
18
0
Was the event…….
Too long
Just right
Too short
11
163
6
Was the speed of the day….
Too quick
Just right
Too slow
1
170
7
General Comments
‘Useful reference for dealing with our client group within the prison
setting.
Emphasised the quality needed by staff for open empathic communication’
‘Excellent – thoroughly enjoyed the day and the insight into disorders
which will help in my day to day dealings with some individuals in
Barlinnie’
‘ I now have an increased awareness of PD. I can see the benefit to me in
my role’
‘ Gave me a good insight into personality disorders, how to identify it in my
job and measures I can put in place to help me work with patients’
‘ Fascinating and very helpful. Wish I’d done this 20 years ago’
Suggestions for future events
‘Over 2 days to allow more time for discussion’
‘Make this course compulsive for all staff who have prisoner contact’
‘Follow up training in venue away from workplace’
‘This should be part of prison officers initial training at the SPS college.
Very interesting and enjoyable’
‘Would like more training to develop my skills’
‘More in depth awareness and range of interventions’
One thing I will change about my
practice is…
‘ Show more empathy’
‘ Try to be more understanding now I know more about PD’
‘ Be more understanding of people’s behaviours without judging’
‘ In future this will raise question marks as to the reasoning behind
someone’s behaviour instead of assuming they are just trying to be
disruptive’
‘Using suggestions during course when dealing with prisoners
displaying PD traits’
Someone with Borderline Personality has a very mild disorder
140
120
100
80
PRE T
POST T
60
40
20
0
Def T Prob Poss Prob Def F
T
T
F
There is no successful treatment for BPD
90
80
70
60
50
40
30
20
10
0
PRE T
POST T
Def T Prob Poss Prob Def F
T
T
F
People with PD cannot change
120
100
80
60
PRE T
POST T
40
20
0
Def T Prob Poss Prob Def F
T
T
F
People with PD can live successful lives
140
120
100
80
PRE T
POST T
60
40
20
0
Def T Prob Poss Prob Def F
T
T
F
Someone with PD can be detained under MHA
120
100
80
60
PRE T
POST T
40
20
0
Def T Prob Poss Prob Def F
T
T
F
Medication is the main treatment for PD
160
140
120
100
80
PRE T
POST T
60
40
20
0
Def T Prob Poss Prob Def F
T
T
F
I feel confident I could recognise that someone has a PD
80
70
60
50
PRE T
POST T
40
30
20
10
AGREE
10
0%
90
%
80
%
70
%
60
%
50
%
40
%
30
%
20
%
10
%
0
DISAGREE
I feel confident that I have the skills to work with someone
with PD
80
70
60
50
PRE T
POST T
40
30
20
10
AGREE
10
0%
90
%
80
%
70
%
60
%
50
%
40
%
30
%
20
%
10
%
0
DISAGREE
People with PD are less deserving than people with other mental
health problems
160
140
120
100
PRE T
POST T
80
60
40
20
AGREE
10
0%
90
%
80
%
70
%
60
%
50
%
40
%
30
%
20
%
10
%
0
DISAGREE
People with PD always have control over their behaviour
120
100
80
PRE T
POST T
60
40
20
AGREE
10
0%
90
%
80
%
70
%
60
%
50
%
40
%
30
%
20
%
10
%
0
DISAGREE
There is nothing I can do to help someone with PD
120
100
80
PRE T
POST T
60
40
20
AGREE
10
0%
90
%
80
%
70
%
60
%
50
%
40
%
30
%
20
%
10
%
0
DISAGREE
some questions
• How much training is enough?
– 1 day introduction?
– 2 day MBT skills?
– More?
• How to sustain interest/ attitude
change
• Service user involvement
Research Project
“Tricky interactions”: exploring mental health
staff responses to stressful interpersonal
sequences following mentalizing skills training
2014/15