The Personality Disorders Service

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1 The Personality Disorders Service Developing Skills to build A life worth living Page 1

2 PERSONALITY DISORDERS SERVICE TREATMENT STRUCTURE The recent restructuring of services in Camden & Islington Foundation Trust has enabled the creation of a coherent treatment programme for all service users of the Trust with a diagnosis of Personality Disorder. This booklet is intended for service users who have been referred to the Personality Disorder service or are being assessed for treatment by the Personality Disorder service. Friends, relatives and professionals may also find it useful. It describes what treatment options are available to service users. Service users can discuss which treatment is most suitable for their problems with the person doing their assessment. Dialectical Behaviour Therapy DBT is a treatment approach designed to help people who have difficulty in regulating (that is: managing) their emotions. This emotional dysregulation often results in a high degree of impulsiveness, self-destructive behaviours, and unstable relationships with others in their lives. DBT works by teaching clients to become more aware of their particular sensitivity to negative emotions such as anger and anxiety. At the same time, it provides the skills necessary to tolerate these feelings and then begin to regulate them. DBT also teaches skills to enable service users to be more effective in their relationships. DBT is an intense therapy requiring the service user to attend two sessions per week, monitor his/her moods and behaviour every day and complete weekly homework. One of the key assumptions of DBT is that while service users may not have caused all of their problems, they are the only ones capable and responsible for fixing them. This requires a continual willingness on the part of DBT service users to put in the hard work necessary for making the changes they want in order to create a life worth living. Therapy structure: Pre-commitment: an initial 10 week group with a DBT therapist intended to: orientate service users to the model; establish a motivation in the service user to make changes; and the setting of agreed target goals that the service user will work on in therapy. Page 2

3 Following the group the service user will also meet with their proposed individual therapist for one or two sessions of pre-commitment work. Service users accepted into DBT treatment are given contracts for an initial period of 6-12 months. The length of treatment is about months in all. Renewal of the contract is something that will be agreed between the service user and their individual therapist. Treatment: DBT involves a combination of a 1 hour individual therapy session per week, a 2 hour group skills training session a week and may include 5-10 minute telephone coaching sessions as and when needed between scheduled sessions (during specific time limits). The skills you will learn include: Mindfulness: Helps people learn to be more in control of their mind, for example focussing on one thing at a time, and to increase awareness of moment to moment experience. Emotion Regulation: Learning how to identify and label emotions; how to decrease vulnerability to negative emotions and increase positive emotional experiences; and act opposite to emotions. Interpersonal Effectiveness: A range of skills that are aimed at helping people to become more effective in their interactions with others; helping you to balancing getting what you want, keeping or improving the relationship and maintaining your self-respect. Distress Tolerance: Teaches people how to survive painful situations or emotions when they can t be changed right away. Mentalisation Based Therapy (MBT): Mentalisation Based Therapy is a time-limited treatment designed to help people who have problems in relationships as a result of difficulty managing their feelings. We make sense of ourselves and others in everyday life by understanding what is going on in our minds and what is going on in other people s mind. This capacity to understand what motivates ourselves and others to behave the way we do, in terms of our states of mind, is known as mentalisation. This can be very important in enabling us to regulate our emotions and impulses, and in developing fulfilling, meaningful relationships. Page 3

4 MBT was originally developed to help people who have had long-term problems in experiencing overwhelming and intense emotional distress, which has led them to engage in impulsive, often self-destructive behaviour, and who have found it difficult to develop trusting relationships. This cluster of difficulties is known in the psychiatric diagnostic system as Borderline Personality Disorder. However, MBT can help anyone who has difficulty in understanding his or her emotional responses to situations, and whose moods fluctuate readily and seemingly inexplicably. It can also help those who have difficulty in reading other people s responses towards them, which can leave them feeling mistrustful, and uncertain about others motives. At The Dartmouth Park Unit MBT will be offered in an exploratory group and an individual psychotherapy setting. It will initially involve getting to know the kind of situations which have tended to provoke strong emotional reactions in you or shifts in your mood states. Early on, your therapist will develop with you a formulation of your key areas of difficulty, with particular reference to how these affect and are affected by your relationships. This formulation is designed to help focus your therapy, but is meant to be flexible and is open to reworking throughout the process. The way that you experience your therapist and/or the other people you are in treatment with, and yourself in relation to them, can be a useful area to explore, and within which to develop and enhance your capacity to mentalise. The group sessions are 90 minutes and the individual therapy sessions are 50 minutes. Service users will be in treatment for up to 18 months. MBTI People who are waiting to start in the full MBT programme will be expected to attend an MBT Introductory Group (MBTI). This is a psycho educational group which offers a 12-week programme. The aim of the group work is to help you to develop and enhance your capacity to mentalise through learning about mentalisation and exploring ways in which mentalisation can go wrong. The group facilitators will introduce you to the principles of mentalisation. They will suggest exercises for you to do with others in the group to develop your understanding of your own and other people s minds. They will also discuss how our relationships and our behaviours are affected by what we have in our minds. Combined MBT and DBT group These groups will run for one year and will combine aspects of Mentalisation Based Therapy and the Skills Development aspect of Dialectical Behaviour Therapy. It aims to help people gain an understanding of their emotions and how to better manage them Page 4

5 using skills that will be taught as part of the group, as well as develop a capacity to understand what motivates ourselves and others to behave the way we do, in terms of our states of mind. Over the course of the year the aim is to empower the person s ability to mentalise as well as teach skills linked to Dialectical Behaviour Therapy, and apply them to the person s real life experiences. New Beginnings: Building a Life Worth Living A ten week pre-treatment group for people on the waiting list for either DBT or MBT therapy. This group is facilitated by a therapist in the Personality Disorders Team and two service user facilitators. The groups will offer you the opportunity to improve your understanding of yourself, your emotions and your relationships. Please note that this group is optional and in no way affects your eligibility for therapy or position on our waiting list. Personality Disorder Service - Community Team The Community Team are a multidisciplinary team including social workers, psychiatric nurses, psychologists and a Consultant Psychiatrist. The Team are all experienced professionals who have had specialist training in working with people who have complex needs that are characterized as personality disorder. Most people that come to the service are likely to have a diagnosis or meet the criteria to be diagnosed with a personality disorder; however there are circumstances where a person is allocated when they may have 'traits' of a disorder and their needs are best met within this team. We also work with people who are young (i.e. 18 +). Services prefer to use the term 'emerging' (personality disorder), so as not to misdiagnose what might be no more than a difficult transition into adulthood. How we work: The Team utilises the Structured Clinical Management (SCM) model; a model that gives clinicians a framework to guide their work with service users based on psychologically informed best practice. The essence of SCM is based on a therapeutic model with case management/advocacy support; problem solving and including self-defined goals and Page 5

6 active crisis planning as part of the on-going work, with medication as an adjunct where appropriate. All of these elements are aimed at engaging people in a way that means they continue to be as independent as possible. This approach to the work we do is not a rigid one but it does give a clear understanding of the ethos that underpins all of our work, one of working with people s strengths and abilities to build a life around their own positive goals. Service users allocated to the Community Team will be placed under the Care Programme Approach if they meet the criteria for this, but whether or not this is the case all allocated service users will make plans with their workers around reviews of care that give them an opportunity to think about their progress at that point and the most appropriate way to move forward. These reviews will involve any family, carers, friends and health/support agencies that are involved with the service user s care and it is agreed with the service user to invite. The Team works with service users around social care as well as psychological needs. This includes housing, financial, physical health and Personal Budget issues that may arise. We are also developing a group programme where sessions can be a stand-alone intervention and/or in conjunction with individual work, or that focus on specific areas in a person s life and difficulties that they wish to concentrate on. Contact us on: between Monday to Friday Or leave a voic message any time. Page 6

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