Rep36 Understanding Personality Disorder

4.9
Supporting staff working with
personality disordered individuals
People with personality disorders can be
physically and emotionally difficult to work with.
It is distressing to see a person regularly attempt
suicide, disfigure themselves through self harm,
or subject themselves to sexual exploitation.
Similarly, it is difficult to understand why
someone you are trying to help would want to
insult you, hit you or reject you. People with
personality disorders often get rejected by
services which do not understand why they do
what they do and, instead, make negative
judgements about them, to make the behaviour
explainable. For instance, pejorative labels such
as attention seeking, manipulative or childish
may be used. The staff in such situations often
feel helpless to effect positive change and can
become disillusioned and depressed. In order to
prevent such a negative chain of events regular
support for staff working with this client group is
essential. Staff need to be given a clear and
coherent model of personality disorder to help
them understand why these individuals respond
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In contrast, the following service provisions were found to be unhelpful by service users: where
the availability of care is determined by postcode; being cared for by staff who do not have the
appropriate training; a lack of continuity in staffing; care in office hours only; care teams that are
unable to fulfil the promises made; staff who are critical of expressed needs or who only respond
to behaviour rather than anticipate and manage changes in behaviour; long-term admissions; staff
who are not interested in the causes of behaviour or who have pessimistic attitudes; a rigid
adherence to a therapeutic model without adaptation to individual needs; abuses of
confidentiality; the use of physical restraint and obtrusive levels of observation; the inappropriate,
automatic or forcible use of medication; the withdrawal of contact used as sanction; and treatment
determine donly by funding/availability/diagnosis.
Ramon, Castillo and Morant (2001) carried out a study in which they trained individuals with a
diagnosis of personality disorder to interview people with a similar diagnosis. A number of
important findings were made. First, the negative impact of the label of personality disorder was
identified along with a gap between the perspectives of service users about their difficulties and
those of the professionals who cared for them. Second, service users commonly reported that a
diagnosis of personality disorder impacted negatively on professional views of them across a range
of different agencies; a diagnosis of personality disorder resulted in an improvement in treatment
for only a minority of the sample (20 per cent). Therefore, the authors concluded that ‘as a rule,
we seem to be at the stage of containment and control, where understanding and sufficiently
effective, caring interventions are an exception’ (p13). These authors suggested that the use of
service users as researchers appeared to gives value to their perspectives on personality disorder
diagnosis and intervention.