Personality disorder, especially borderline personality disorder (BPD), is a ‘hot’ topic both politically and clinically. Mental health practitioners have been told by their political masters that they must treat patients with personality disorders, and have been criticised for not doing so even though there is limited knowledge about how to manage and treat them appropriately within general adult mental health services. This book goes some way towards addressing this issue and increasing our skills in routine practice. It summarises the basic knowledge of BPD and provides a practical guide to its management in community services.
The reader will not be disappointed. It is not a book for those people seeking information about specialist treatment but more a handy guide for the generic practitioner. It does exactly what the title suggests; it focuses on the practicalities of the treatment of BPD within mental health services. Although background theoretical and research information is covered, the book focuses on treatment issues such as assessing and monitoring risk, implementing care plans, and delivering treatment programmes. Using frequent clinical examples, treatment issues and clinical pathways form the core section of this book. A framework for management is provided, a guide to assessment presented, proformas for crisis plans given, and exemplary clinical plans outlined. Importantly for the clinician, there is discussion of common problems such as self-harm, when to admit to hospital, how to manage the patient in hospital, what level of risk to accept, managing countertransference, and maintaining boundaries. Rightly, the authors take a ‘ high risk’ approach, recognising that patients have to be helped to manage their own risk and not have it managed for them by an overprotective, risk-averse mental health team.
One small criticism is that, in their quest to be practical and informative, the authors become overly behavioural in their solutions. It is as if the only useful interventions for practitioners are action-based. There is little emphasis on understanding the psychological processes of borderline patients and linking these to verbal therapeutic interventions or even masterly inaction. However, perhaps that is for a more specialist book. As a treatment primer this book is the best on the market.
Oxford: Oxford University Press, £24.50 pb, 201pp, ISBN: 0 19 852067 0