Book contents
- Frontmatter
- Contents
- List of tables
- List of boxes
- List of figures
- List of contributors
- Foreword
- Part 1 The nature of the problem
- Part 2 Management and general treatment approaches
- 9 Assessment of personality disorder
- 10 Diagnosis and classification of personality disorder: difficulties, their resolution and implications for practice
- 11 Murmurs of discontent: treatment and treatability of personality disorder
- 12 Personality disorder: its impact on staff and the role of supervision
- Part 3 Specific treatment approaches
- Index
12 - Personality disorder: its impact on staff and the role of supervision
from Part 2 - Management and general treatment approaches
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- List of tables
- List of boxes
- List of figures
- List of contributors
- Foreword
- Part 1 The nature of the problem
- Part 2 Management and general treatment approaches
- 9 Assessment of personality disorder
- 10 Diagnosis and classification of personality disorder: difficulties, their resolution and implications for practice
- 11 Murmurs of discontent: treatment and treatability of personality disorder
- 12 Personality disorder: its impact on staff and the role of supervision
- Part 3 Specific treatment approaches
- Index
Summary
Summary Over the past decade attention to the provision of healthcare for individuals with personality disorder, particularly those who pose a risk to others, has substantially increased. Keeping pace with such developments with a suitably trained, consistent and motivated workforce, interfacing health and criminal justice systems where necessary, presents an enormous challenge. Staff must be experts in managing conflict at every level, while sustaining an optimistic and therapeutic orientation. Boundaried relationships provide the context for recovery for patients. Key principles and practices likely to promote resilience in personality disorder services, with a focus on the role of supervision, are outlined in order to support staff in keeping themselves afloat, their patients safe and their services on target.
‘Staff are asked to engage the unhoused and the dangerous with all the physical and psychological intimacies of a feared hand-to-hand combat whilst also supposedly retaining an attitude of care and concern for a potential enemy.’
(Scanlon & Adlam, 2009: p. 133)Spending time in the company of people with personality disorder is emotionally demanding (Cox, 1996; Alwin et al, 2006; Kurtz & Turner, 2007; Aiyegbusi, 2009). This complex work hardly gets a mention when things are going well, and perhaps rightly so, as it is the service recipients who make the changes that in turn can re-establish the confidence of others in them. Conversely, when things go wrong, the effect for all can be devastating.
In an ideal world, professional carers are trained to approach their task in a systematic way, have the advantage of peer support from colleagues who understand the aims of the job, and use both educational and supervisory frameworks for guidance. Training provides an academic understanding of personality disorder and can make an important difference to the extent to which problematic behaviour can be tolerated. A capacity to understand traumatic interpersonal situations is likely to limit their impact, and to operate as a protective factor for vulnerable persons (Fonagy & Target, 1997). Staff working with patients with a high propensity to act dangerously cannot operate safely without the support of colleagues and within an informed system that is designed to allow space for reflection.
- Type
- Chapter
- Information
- Clinical Topics in Personality Disorder , pp. 188 - 210Publisher: Royal College of PsychiatristsPrint publication year: 2012