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1/10 V. interesting new paper raising important questions about access to psychological therapy for people diagnosed with a personality disorder. We don't talk about this enough. What do others think? @Keirwales @tamar_whyte @gazlamph. I have very mixed feelings on the idea of... https://twitter.com/TheBJPsych/status/1273581237895147520
2/10 ..."readiness" for treatment. The paper argues it's better to wait than fail trying. Supporting this, as a researcher working for many years alongside ppl receiving specialised psychological therapies in personality disorder services, I have seen the distress ppl experience.
3/10... when they are unable to complete and/or do not benefit from therapy. They feel they've failed, they feel let down by services, and they feel their last hope - the highly "specialised" treatment they may have waited years to access - is gone. The reasons this happens are..
4/10 ...complex - in some cases perhaps the person wasn't "ready" for the reasons outlined in this paper, but equally there are often other personal, therapist-, therapy-, or system-related barriers in play. On the other hand, I've also seen many cases where the factors listed...
5/10 ...as exclusion criteria in the paper - marked chaotic or risky behaviour, and harmful or dependent alcohol or drug use - are actively and successfully worked on as treatment targets in therapy, rather than considered exclusionary. This is perhaps particularly the case in...
6/10... services using a DBT model, where changing these patterns of behaviour is seen as integral to the therapeutic model. Yet despite the fact that risk to self and self-damaging behaviours such as drug use are 2 of the criteria for a diagnosis of "EUPD", a 2015 survey found
7/10...that 53% of dedicated personality disorder services still exclude ppl on the basis of uncontrolled substance misuse and 5% on the basis of active risk to self (Dale et al. 2017). The 2019 RCPsych consensus statement stressed that some ppl may need more help to engage with
8/10..treatment than others and that the responsibility for this rests with the clinician rather than solely with the patient. Linked to this, it was good to see suggestions in the paper for what generic community mental health services can do to help increase ppl's "readiness"..
9/10 ... for therapy - e.g. distress tolerance skills, help with housing & employment, psychoeducation, motivational interviewing... I think this paper very usefully highlights that we need research to evaluate what strategies work to prepare ppl for therapy, and it's vital to...
10/10...adequately train & resource community mental health teams to be able to help ppl to access evidence-based psychological treatments if this is what the person wants to do. As neither a clinician nor person with lived experience myself I wld love to hear others' thoughts!
