Rep36 Understanding Personality Disorder

4.3
The need for specialist psychological
skills within personality disorder services
The NIMHE guidelines and capabilities
framework stress the need for psychosocial
treatments and the primacy of psychological
models and therapies in treatment. To
implement such a service model would require a
change of working practice within forensic and
mental health services. Currently many services
work on a medical diagnostic approach to
personality disorder with treatment based upon
observed symptoms (e.g. anxiety, depression, self
harm). A psychological approach would place
more emphasis upon a formulation of an
individual’s needs based upon functional
difficulties (e.g. homelessness, impulsivity,
frustration). The importance of skills in
assessment and formulation are outlined in
recommendation 4.4. In addition, analysis of the
skills of clinical psychologists (Management
Advisory Service, 1989) indicates they combine
information from the academic and clinical
knowledge base to develop individually tailored
treatment packages. Such a change in service
delivery would necessitate the development of
services with clinical/forensic psychologists
employed as clinical leaders within specialist
personality disorder teams, with a remit to
provide assessment, treatment, research,
consultancy, training and supervision. 
4.4
Structured assessments and detailed
case formulations are an essential
component of services for individuals with
personality disorder
The assessment of personality as a component of
mental health problems is a sophisticated
undertaking. It requires a good understanding of
psychological theory, especially developmental
psychology, trauma-related phenomena, assessing
organic dysfunction, and personality theory. The
assessment process needs to combine a wide
ranging clinical interview, focused upon a need
to reach a shared understanding of an
individual’s interpersonal, social and
psychological difficulties, and an objective
assessment of personality functioning to assess an
individuals coping style. Behavioural observation
may be useful in some cases and assessment of
risk to self and others needs to be incorporated.
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In addition, it may be helpful where possible,
and with the consent of the individual, to obtain
information from family members and friends.
This can enrich the assessment process and
provide an alternative perspective that can
corroborate or challenge the individual’s
presentation of their problems. Psychometric
assessment, including assessment of personality,
intellectual functioning, learning difficulties,
social and assertiveness skills and mood, may also
be helpful. 
The assessment process needs to inform a
clear conceptualisation, or formulation, of why
an individual has developed the problems
manifest in their presentation and how this relates
to their life experience and biological inheritance.
This formulation can then form the basis of
collaborative interventions to address issues of
concern and can be updated and amended as
new information becomes apparent from the
individual’s self-disclosure and/or behaviour,
further disclosure from family members/friends
and observations of the individual by professionals
involved in their care. This formulation should
always be open to amendment and be
considered the best working model of an
individual’s difficulties currently available. 
This report has provided some basic
guidelines for assessing personality disorders,
both in terms of making the choice of assessment
procedure and good practice in the conduct and
interpretation of assessment processes.