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Taking the therapeutic community outside in the COVID-19 pandemic
- Authors:
- JONES Merryn, HOWE Andrew John
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 42(2), 2021, pp.89-97.
- Publisher:
- Emerald
Purpose: The COVID-19 pandemic has affected psychotherapy practice. A common change is a move to online sessions over video calls. In their therapeutic community (TC) for those with personality disorders, the authors have used video calls but not all clients could work in this way. The authors decided to meet patients outside and walked with them while adhering to government guidelines. This study aims to present the authors’ experience with one client who was interviewed afterwards about the experience. Design/methodology/approach: A total of 10 walking therapy sessions of 60-min duration were conducted with the patient. After the sessions, both the patient and therapist were interviewed about their experience. The resulting interviews with both patient and therapist were thematically analysed independently by both authors. Findings: There were common themes to both the client and therapist’s account following thematic analysis. These were: modelling and normalising in the real world, replacing what COVID-19 had taken away from the TC experience, changes at home, therapist disclosure, outcomes and good endings and being outside of the clinical environment. Research limitations/implications: The authors have presented a single case of the patient and therapist experience of outdoor therapy sessions in a TC context response to the COVID-19 pandemic. The findings are not generalisable and can only provide a suggestion at the positive potential for working in this way. The authors hope that the positive effects of outdoor therapy noted here may inspire other clinicians to consider similar novel approaches in their work. Originality/value: This study describes a novel way that a TC has adapted to the COVID-19 pandemic. (Edited publisher abstract)
Exploring offender manager’s experiences of psychologically informed consultation on relationships with service users within the offender personality disorder pathway
- Authors:
- RADCLIFFE Kay, CARRINGTON Bethany, WARD Max
- Journal article citation:
- Mental Health Review Journal, 25(4), 2020, pp.317-328.
- Publisher:
- Emerald
Purpose: The Yorkshire and Humber Personality Disorder Partnership (YHPDP) provides psychological consultation and formulation to offender managers (OMs) within the National Probation Service as part of the offender personality disorder (OPD) pathway. The pathway highlights the importance of formulation-led case management to develop pathways for offenders with personality difficulties at high risk of causing serious harm to others. This study aims to ask what is the experience of psychological consultation/formulation on the relationship between a sample of service users (SUs) and their OMs. Design/methodology/approach: Semi-structured interviews were undertaken with five OMs who had engaged in at least three consultations with YHPDP psychologists/psychotherapists within the OPD pathway. Qualitative methods were used to analyse the data, specifically interpretative phenomenological analysis, which is useful when dealing with complexity, process or novelty. Findings: OMs experienced the consultation/formulation process to be containing and reflective. They found complex, emotionally demanding clients who have offended and have personality disorder traits could be responded to differently as a result of this process. From an OM perspective, this improved the relationship between themselves and their SUs and supported risk management. These conclusions must be tentative, as they are drawn from a small-scale qualitative study, but provides the basis for further research. Originality/value: Although there is increasing research into the outcomes of the OPD pathway, little has been done regarding the experience of the relationship between OMs and SUs. This research takes a qualitative perspective to explore this area. (Edited publisher abstract)
The third position
- Authors:
- LEES Jan, LOMAS Fiona, HAIGH Rex
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 40(3-4), 2019, pp.125-131.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to describe the role of the expert by experience, and its benefits and challenges. Design/methodology/approach: Review of the relevant literature and a case study has been performed. Findings: The role of the expert by experience is fluid and complex. Staff need to understand the ambiguities of the role. Practical implications: Experts by experience (XBXs) play an important role in therapeutic community (TC) practice. They need support and supervision. Staff need to learn about the complexities and fluidity of the role, and to be aware of its transitional position between service user and staff member. Social implications: XBXs challenge the binary notion of staff and service user. The role calls for a different relational rather than procedural conceptualisation. Originality/value: This is the first description of the lived experience of an expert by experience, working in a therapeutic community setting, with the analysis of the helpful and unhelpful aspects of the role. (Edited publisher abstract)
A more promising architecture? Commissioners’ perspectives on the reconfiguration of personality disorder services under the offender personality disorder (OPD) pathway
- Authors:
- TREBILCOCK Julie, et al
- Journal article citation:
- Mental Health Review Journal, 24(4), 2019, pp.306-316.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the views of NHS England (NHSE) and Her Majesty’s Prison and Probation Service (HMPPS) commissioners about the Offender Personality Disorder (OPD) pathway. Design/methodology/approach: A thematic analysis of four semi-structured interviews with NHSE and HMPPS commissioners is conducted. Findings: Commissioners offered a cautious but confident assessment of the potential effectiveness of the OPD pathway, drawing particular attention to its potential to enhance the confidence and competency of staff, offer better value for money and provide enhanced progression routes for offenders with personality disorders. Additionally, commissioners identified a number of potential risks for the pathway including wider system flux, funding availability, multi-agency working, offender engagement and the need to evidence effectiveness. Research limitations/implications: The analysis is based on a small number of interviews. However, there are only a limited number of commissioners involved with the OPD pathway. Practical implications: While the stronger focus on progression in the OPD pathway is a welcome departure from a narrow focus on high security Dangerous and Severe Personality Disorder (DSPD) services, the foundations of the OPD pathway ultimately lie with the DSPD programme and similar challenges are likely to follow. The system within which the pathway operates is subject to a great deal of flux and this inevitably poses significant challenges for pathway services, staff and offenders, as well as for those of us charged with its evaluation. Originality/value: There has been limited empirical work with commissioners in the mental health field. The paper offers a unique insight into the perspectives of those responsible for commissioning the OPD pathway. (Publisher abstract)
Exploring multi-disciplinary team meetings on a personality-disorder ward within a forensic setting
- Authors:
- LEESE Maggie, FRASER Kim
- Journal article citation:
- Mental Health Review Journal, 24(3), 2019, pp.160-170.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to understand how patients on a low security personality disorder ward experienced multi-disciplinary team (MDT) meetings, in order to suggest improvements that would benefit the patients and clinical teams. Design/methodology/approach: The design was a case study where all patients on a low secure ward that specialised in personality disorders were approached to take part in the research. The study utilised non-participant observations of the MDT meeting (n=11), followed by individual interviews with the patients (n=10). Findings: The data were subjected to a thematic analysis and this illuminated five themes relating to the patients’ experience of the MDT meetings namely, the importance of leave applications, the formality of the meetings, the opportunity to check on progress, decision-making and the importance of communication. Practical implications: The findings suggest that small changes could be made to improve the patients’ experience of the MDT meeting. These included the provision of a less formal setting, ensuring a system where leave can be requested confidentially, greater transparency about the content of progress reports, and clearer communication between the MDT and the patient after the meeting. Originality/value: There is limited research that has explored patients’ experiences of MDT meetings within secure forensic settings, and the use of non-participant observations of the MDT meeting followed by semi-structured interviews meant that the researcher and the patient had a shared experience that formed the basis of the later discussion. (Edited publisher abstract)
“Give it a Try”: experiences of black, Asian and minority ethnic young men in a prison-based offender personality disorder service
- Authors:
- HUNTER Stephanie, CRAIG Eleanor, SHAW Jake
- Journal article citation:
- Journal of Forensic Practice, 21(1), 2019, pp.14-26.
- Publisher:
- Emerald
Purpose: Within the current offender personality disorder (OPD) pathway in the UK, black, Asian and minority ethnic (BAME) populations are underrepresented. Fewer BAME offenders are engaging with services despite being proportionately identified for inclusion and referred on to the pathway. The paper aims to discuss this issue. Design/methodology/approach: This qualitative study explored the experiences of 11 BAME men engaged in a prison-based OPD service for young offenders to identify the highlights and challenges of engagement within the service and to what extent they experienced a sense of inclusion/belonging. Findings: Thematic analysis was used to identify three overarching themes and sub-themes. Why am I going to be an Outcast? describes the barriers to engagement encountered by the participants; and Give it a Try and Nothing but Respect describe the process of overcoming these barriers. Barriers revolved around the experiences of judgement, alienation and hopelessness. These were overcome through peer encouragement, developing relationships with staff and freedom to regulate levels of engagement. Practical implications: Practice and policy implications are considered to support similar services in addressing the barriers to engagement faced by BAME individuals. Areas for future research are also recommended. Originality/value: Currently, no research has directly explored the under-representation of young BAME offenders with emerging personality disorder in the OPD pathway. The findings provided an insight into some of the difficulties these young BAME offenders faced when accessing this service, alongside aspects which maintained their engagement. (Edited publisher abstract)
Introducing the recovery inspiration group: promoting hope for recovery with inspirational recovery stories
- Authors:
- ELSEGOOD Kelly J., ANDERSON Lucinda, NEWTON Rachel
- Journal article citation:
- Advances in Dual Diagnosis, 11(4), 2018, pp.137-146.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to undertake a preliminary evaluation of a novel intervention – Recovery Inspiration Group, which uses recovery stories to promote hope and inspiration for recovery among people with complex mental health difficulties. Design/methodology/approach: The Recovery Inspiration Group was delivered to women on a specialist personality disorder inpatient unit, who were concurrently participating in a dialectical behaviour therapy (DBT) Programme. In total, 12 service users participated in the RIG and as part of the intervention, wrote down key reflections after hearing each recovery story. A thematic analysis of these reflections formed the primary basis of the evaluation. Descriptive statistics derived from a service user feedback survey (n=6) supplemented the qualitative findings. Findings: Three themes were identified in the qualitative data, suggesting that participants had engaged with recovery-oriented reflections and experiences: recovery stories as validating and inspiring; Generalisation of DBT skills; shifting perspectives of recovery: doing better rather than being better. The survey results unanimously endorsed the RIG as a worthwhile and validating experience, which participants would recommend to other service users. Practical implications: Recovery Inspiration Group appears to be a low-cost and easily replicable intervention with the potential to promote hope and inspiration for recovery among people with complex mental health difficulties. Originality/value: Recovery Inspiration Group is a novel approach to harnessing the wisdom of people with lived experience of mental health difficulties, to foster hope among users of mental health inpatient services. (Edited publisher abstract)
Remarkable lives: Jo Mullen in conversation with Jerome Carson
- Authors:
- MULLEN Jo, CARSON Jerome
- Journal article citation:
- Mental Health and Social Inclusion, 22(3), 2018, pp.121-127.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide a profile of Jo Mullen. Design/methodology/approach: Jo provides a short background to her life and is then interviewed by Jerome. Findings; Jo tells us about the teaching resources that she has developed to increase understanding of Borderline Personality Disorder (BPD). Research limitations/implications: While this is a single case study, it contains numerous helpful insights of how Jo has developed and presented her work, along with two mental health nurses, and of the high quality educational interventions she has produced. Practical implications: Jo presents a model of co-production, where service partner and mental health professional are equals. Social implications: It would be helpful if mental health services invested in supporting talented individuals like Jo, to develop and disseminate the tools she has created. Originality/value: Thus far Jo has written her own personal account of what it is like to cope with BPD, a bigger training resource, “Wot R U Like?” and a board game, Personapoly, to help individuals solve social and personal problems. (Edited publisher abstract)
Can an interactive e-learning training package improve the understanding of personality disorder within mental health professionals?
- Authors:
- LAMPH Gary, et al
- Journal article citation:
- Journal of Mental Health Training Education and Practice, 13(2), 2018, pp.124-134.
- Publisher:
- Emerald
Purpose: personality disorder is reported to elicit strong emotional responses and negative attitudes in mental health staff (Bodner et al., 2015). The purpose of this paper is to provide an overview of the design and development of a co-produced e-learning training package for personality disorder awareness and an evaluation of its effectiveness. This study was carried out to explore if e-learning is an effective mode of training delivery for raising personality disorder awareness. Design/methodology/approach: the e-learning was uniquely developed by subject matter experts working in co-production with people with lived experience. Self-reported measures were completed at three separate intervals to evaluate the effectiveness of the training: at pre-, post- and three-month follow up. Quantitative data were collected via these questionnaires. Findings: the results from this evaluation show that e-learning is an effective mode of delivery for raising the awareness of personality disorder among mental health professionals, achieving similar outcomes to those reported following face-to-ace training. Research limitations/implications: attrition at follow-up phase was high which was consistent with other similar studies. The evaluation was led by the lead contributors and in the geographical area of its development. The study was relatively small and the participants were self-selected, therefore findings should be treated with caution. Practical implications: e-learning can provide flexible training to compliment and act as an alternative to face-to-face personality disorder training. E-learning may provide an alternative refresher course to knowledge and understanding framework or other face-to-face methods. Co-produced training can be mirrored within an e-learning programme, careful planning to ensure the service user voice is heard and that their lived experience is embraced is required. Originality/value: this is the first evaluation of a co-produced e-learning only personality disorder awareness training. It is also the first paper to carry out a review of the published evaluations of personality awareness training in the UK with comparisons explored across the studies. (Publisher abstract)
Group art therapy: supporting social inclusion through an ancient practice?
- Author:
- HOLTTUM Sue
- Journal article citation:
- Mental Health and Social Inclusion, 22(1), 2018, pp.6-12.
- Publisher:
- Emerald
Purpose: Group art therapy involves art-making, which has been used throughout human history to symbolise struggle and transformation with group support. The purpose of this paper is to discuss two recent papers on how and why group art therapy may be helpful. Design/methodology/approach: A search was carried out to find recent papers on group art therapy, with a focus on how and why it may be helpful. Findings: One paper reported on 119 accounts of why group art therapy may be helpful. Five things seemed specific to group art therapy: using artworks to express experiences symbolically, connect with others, place confusing feelings outside oneself, and be playful, and following a set routine with others. The other paper reported in detail on group art therapy sessions with people who had a diagnosis of borderline personality disorder. Group interaction became most supportive when the art therapist clearly focused on people’s thoughts and feelings about artworks made by group members. Originality/value: It has been unclear how group art therapy may help people. Understanding this means researchers can do more rigorous research on it. The two papers discussed represent probably the largest synthesis of different sources on how group art therapy might work, and the most detailed observation of what happens in practice. Both papers suggest group art therapy uses art to symbolise struggle and transformation with support from others, thus normalising this process and including those going through it rather than marginalising them. Parallels can be drawn with older healing rituals, in which crisis and struggle were viewed as normal. (Publisher abstract)