The public mental health setting wherein clinicians work with clients diagnosed with borderline personality disorder (BPD) provides a continual challenge for clinicians. For many decades a pervasive therapeutic pessimism has surrounded any discussions of attempts to work with clients with BPD with this population being viewed as ‘too difficult’ and ‘impossible to work with’. This pessimism and the ensuing counter therapeutic responses have been well documented in the psychiatric literature.
The development of treatments such as dialectical behaviour therapy (DBT), a cognitive-behavioural therapy, for BPD has provided a basis for therapy for which there is increasing evidence of successful outcomes. Despite this evidence, the pervasive pessimism has been slow to lift. A limited literature explores attempts to positively influence clinician responses to this clientele.
Within the public mental health service in which this research is based, DBT is well-established as a therapeutic modality. In the course of providing training, consultation and supervision for parts of this service, anecdotal evidence emerged suggesting that the impact of practising as a DBT therapist was greater than anticipated and DBT may provide a tool for facilitating a positive change in clinician responses.
Given that this perception is not described in the literature it was appropriate to begin research in this area employing a qualitative methodology. This research explored the experience and impact upon mental health clinicians in a public mental health service undertaking training in DBT and practicing as DBT therapists. In-depth, semi structured interviews were conducted in July 2005 with clinicians practising as DBT therapists.
Data analysis revealed a marked shift in perspective from ‘management to treatment’. Participants described positive professional and personal impacts of training and practising as DBT therapists. An enhanced capacity for self-awareness and ‘living life to the full’ was described by a number of participants.
This initial research suggests that the practice of DBT by clinicians can generate a positive shift in both personal and professional identities that translates into a more optimistic and humanistic approach to clients diagnosed with BPD. Such a change may represent a significant challenge to the prevailing mental health discourse and practice