Beyond the walls of Camden & Islington personality disorder service: a qualitative study of clinical consultation to external services

Abstract

The Camden and Islington Personality Disorder Service (PDS) increasingly provides clinical consultation to external services. There is a dearth of research on the experience of clinicians delivering such consultation. Interviews were conducted with clinicians from the PDS, and a semantic Thematic Analysis was conducted on transcripts to answer the question, ‘What is the experience of Personality Disorder Service staff providing input to staff in external services?’ 13 sub-themes under four overarching themes were identified (these latter were: Anxiety, Fragmented Co-working, Task Difficulty, and Positive Outcome). These themes provide an overview of the experience of consulting clinicians. Themes are explored through Kleinian psychoanalytic theory, with reference to Bion’s work on containment and groups. Findings suggest that staff need to retain thinking space to work effectively, to feel safe and recover a sense of competence when it is attacked, highlighting the need for access to structures such as supervision. The responsibility for trying to reduce distress, risk (to self, to and from others) and functional disability of people with a diagnosis of personality disorder cannot belong to one person or service but services need to be able to think together to gain a better understanding and have an agreed cross-service response.

Keywords:

• personality disorder
• consultation
• thematic analysis

Acknowledgements

We would like to thank our interviewees for taking part in this research. We would also like to thank two service-users who reviewed and amended a draft of this article, who will remain anonymous in order to preserve confidentiality.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. We are aware that the term ‘personality disorder’ is a controversial one, and we side with the Consensus Statement of 2018 (Mind, 2017), in acknowledging that it is imperfect semantically and ontologically. However, for the purposes of this research, given that a diagnosis of personality disorder is necessary to come under the service where the research took place, we will continue to use this diagnostic term throughout this paper. In particular, we will use the phrase ‘people with a diagnosis of personality disorder’ to refer to our service-users; though this is not always observed in the literature reviewed below, and in some of the quotes from our interviews. In practice the PDS uses as a starting point a broad definition of personality disorder such as that provided in the co-produced publication of Bolton et al. (2011): ‘“Personality disorder” is the term used within mental health to describe longstanding difficulties in how an individual thinks and feels about themselves and others, and consequently how they behave in relation to other people.’