Personality Disorder Training; what is the point? Andy Williams, Consultant Psychiatrist in Psychotherapy Sue Wallace, Sen. Adult Psychotherapist, Mandy Carruth, Nurse Therapist Personality Disorder and Homelessness Team NHS Greater Glasgow and Clyde

Background Almost 8 years experience of PD training in homeless services in Glasgow Recent experience of training in prisons What have we learned about how to do it? What level of training is right? What style of training is right?

PD and Homelessness Team the context Psychodynamic psychotherapy – MBT Small resource City-wide Remit to work across agencies Emphasis on consultation and TRAINING

PD and Homelessness Team Expectations of what training could achieve Reduce repeat homelessness ! Give staff Tools Strategies to manage/ cope with difficult behaviour

What are requests for training about? feeling of being overwhelmed by the work interest to know more about the subject stress/ anxiety in the organisation not knowing how best to support someone someone else might know what to do – an expert?

What are requests for training about? feeling of being overwhelmed by the work interest to know more about the subject “My manager told me to come” stress/ anxiety in the organisation not knowing how best to support someone someone else might know what to do – an expert?

What are we trying to achieve? Change in: knowledge skills attitude

practice makes perfect… 2006 – 2014 8-10 training days/ year Total of 1,331 staff trained

in the beginning……

transference and countertransference reflective practice Can people think more about what is going on for the person with personality disorder? and for themselves, and their teams? transference and countertransference splitting

Can people keep in mind the possible origins of “difficult” behaviour? genes temperament Can people keep in mind the possible origins of “difficult” behaviour? and think about development/ early attachment attachment

Can people shift to a more empathic position? curiosity Can people shift to a more empathic position? empathy

Draw a picture

Elements in the 1 day Introduction to PD training A lot about attachment and the relationship A fair bit of thinking about scenarios A wee bit on definitions and categories of personality disorder Group work Controversies Complexity Discussion

Could we adapt this for prison settings? Thanks to: Dr Alex Quinn, Cons Forensic Psychiatrist NHS Lothian Dr Jo Brown, SpR in Forensic Psychiatry, NHS Lothian

Personality Disorder Training for SPS and prison healthcare staff 10 training days over a 6 month period from Jan to June 2014 Barlinnie 4 days Greenock 2 days Low Moss 4 days Total of 186 staff

Write on a picture

What was different? more time on antisocial/ psychopathy paranoid and schizoid also included more forensic cases/ issues discussed more about criminality and responsibility humility humour

More time on Empathy and distinguishing from Collusion Can empathise without agreeing Not the same as taking side of prisoner Discuss concerns about “looking soft” in front of colleagues Concerns about being “taken in”

Managing BPD Cold/ hostile Empathic consistent inconsistent Key Approaches Cold/ hostile Empathic inconsistent consistent Un-boundaried boundaried

some graphs…. Question 1: How well did the learning event meet your aims/ objectives? Question 2: How relevant was the content of the event to your work? Question 3: Please rate the presentation of information Question 4: Suitability of audio/visual aids (eg slides, video) Question 5: Suitability of venue

How much of the event did you find interesting? 161 18

Was the event……. 11 163 6

Was the speed of the day…. 1 170 7

General Comments ‘Useful reference for dealing with our client group within the prison setting. Emphasised the quality needed by staff for open empathic communication’ ‘Excellent – thoroughly enjoyed the day and the insight into disorders which will help in my day to day dealings with some individuals in Barlinnie’ ‘ I now have an increased awareness of PD. I can see the benefit to me in my role’ ‘ Gave me a good insight into personality disorders, how to identify it in my job and measures I can put in place to help me work with patients’ ‘ Fascinating and very helpful. Wish I’d done this 20 years ago’

Suggestions for future events ‘Over 2 days to allow more time for discussion’ ‘Make this course compulsive for all staff who have prisoner contact’ ‘Follow up training in venue away from workplace’ ‘This should be part of prison officers initial training at the SPS college. Very interesting and enjoyable’ ‘Would like more training to develop my skills’ ‘More in depth awareness and range of interventions’

One thing I will change about my practice is… ‘ Show more empathy’ ‘ Try to be more understanding now I know more about PD’ ‘ Be more understanding of people’s behaviours without judging’ ‘ In future this will raise question marks as to the reasoning behind someone’s behaviour instead of assuming they are just trying to be disruptive’ ‘Using suggestions during course when dealing with prisoners displaying PD traits’

Someone with Borderline Personality has a very mild disorder

There is no successful treatment for BPD

People with PD cannot change

People with PD can live successful lives

Someone with PD can be detained under MHA

Medication is the main treatment for PD

I feel confident I could recognise that someone has a PD AGREE DISAGREE

I feel confident that I have the skills to work with someone with PD AGREE DISAGREE

People with PD are less deserving than people with other mental health problems AGREE DISAGREE

People with PD always have control over their behaviour AGREE DISAGREE

There is nothing I can do to help someone with PD AGREE DISAGREE

some questions How much training is enough? 1 day introduction? 2 day MBT skills? More? How to sustain interest/ attitude change Service user involvement

Research Project “Tricky interactions”: exploring mental health staff responses to stressful interpersonal sequences following mentalizing skills training 2014/15