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Treating Personality Disorder: Creating Robust Services for People with Complex Mental Health Needs

Naomi Murphy and Des McVey, eds. Treating Personality Disorder: Creating Robust Services for People with Complex Mental Health Needs. New York: Routledge, 2010. x + 308 pp., ISBN 978-0-415-40480-8 (hbk)

Personality disorders affect those persons with this illness as well as those family members, friends, and workiTreatingPersonalityng professionals who interact with them. Moreover, there is considerable disagreement, Naomi Murphy and Des McVey say, about the ability to even treat this condition. They note that one thing is certain: The “use of maladaptive coping strategies” is common, and often people taking this approach to day-to-day interactions end up being disposed in the criminal justice system. Among the problematic behaviors these people manifest are alcohol, drug, gaming, and sexual addictions; violence; self-neglect and self-injury, and suicide and homicide. “In prisons,” the editors’ report, “those with the most need of containment are often regularly moved from prison to prison as they are considered uncontainable.”

McVey and Murphy, a psychotherapist and psychologist, observe that personality disorders can be treated in a number of different contexts. The 13 articles in this volume, most written by working practitioners, make an effort to improve clinical services while adapting the management structures necessary for such services. These articles cover staff difficulties treating persons with personality disorders, the integrated treatment of people with personality disorders, treatment strategies and organizational challenges in optimizing and providing services for persons with personality disorder, effective transdisciplinary teamwork, and the roles of nurses, occupational therapists, prison officers, psychiatrists, and psychologists in treating people with personality disorders.

Murphy and McVey identify a series of challenges that confront prison staff and others working with persons with personality disorders: inadequate professional training; low levels of client recognition and reinforcement, including rejection of staff efforts; difficulties perceiving patient vulnerabilities, including competence and comprehension; and staff fears of their own vulnerability, including traumatization and loss of professional integrity. Staff members working on personality disorder cases require certain personal qualifications, such as a desire to work with this group of people, good emotional regulation skills, self-reflection and self-esteem, a good sense of their professional identity, the ability to set limits and to meet challenges; and a psychological understanding of personality disorder, including the ability to assess vulnerability and to acknowledge improvement.

In a separate article on creating and maintaining an effective transdisciplinary team, Murphy observes, “Transdisciplinary teams are an essential component of treatment with people with personality disorder with multiple treatment needs. Failure to attend to the tasks involved in transdisciplinary teamwork is likely to lead to a poorly functioning team and impact negatively upon the mental health of both service users and team members. In order to ensure the team functions effectively, work must be completed to ensure the team is adequately prepared for, has clarity of membership, accountability, roles, operational policies/ procedures, communication and decision-making pathways, and clear relations with other services. Team members need a common catchment area/ client group, common goals and philosophy, shared knowledge and participatory safety.”

Accordingly, she outlines steps for preparing transdisciplinary teams; establishing clarity of membership, accountability, roles, operational policy and procedures, communications, and relationships with host organizations; reducing “unhelpful” differences through shared goals, philosophy and knowledge; and participatory safety through frequent interaction and effective conflict resolution.

In the volume’s concluding article, Elizabeth Sneath, a forensic psychologist, observes, “Providing robust treatment for people with personality disorder requires clinicians not only to develop particular skills and draw on specific personal qualities but also to have access to good systems for support and supervision.” For Sneath, staff selection is critically important. She identifies training needs, staff knowledge, difficulties in training staff, treatment-interfering behavior, supervision issues, formal and informal support opportunities, maintaining positive practice cultures, and successfully linking with other groups and resources.

Posted Fri, Jan 28 2011 2:51 PM by Tracey Vessels


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