Senior Clinical Psychologist, Andrew Phipps, started his talk by arguing that hospitalisation does not effectively assist people with Borderline Personality Disorder. He argued the advantages of using Dialectical Behaviour Therapy (DBT) include:
- Little difference in outcome between the different psychotherapies available for Borderline Personality Disorder
- Behaviour therapy is accessible to a range of disciplines, with a range of experience
- Initial training for clinicians can occur within 1 week
- Responsiblity can be shared between several clinicians
- DBT is effective over a one-year period
He then introduced the Liverpool DBT program. This program has been run for 8 years with focus on high risk and/or high service utilizers. There are 198 referrals to date. The team size fluctuates between 3 to 8 clinicians.
The program lasts for 12 to 18 months, with focus on reducing harmful behaviours and hospital admission in community. The treatment includes: weekly individual therapy (1 hour); weekly skills training group (2 hour), phone coaching, and a weekly consultation group for clinicians.
Group skills training has four modules:
- Mindfulness – increasing awareness of self and attention capacity – identity disturbance
- Distress tolerance – increasing ability to effectively cope with distress rather than resorting to damaging behaviour – self harm/suicide
- Interpersonal effectiveness -- establishing and maintain healthy and rewarding –interpersonal chaos
- Emotion regulation – to increase control over emotions – and decrease affect instability
- Andrew Phipps began by discussing the changes that have occurred over the past 10 years regarding treatment for individuals with BPD. The changes that are occurring are positive steps towards consumers receiving best practice and quality care. DBT is a promising treatment for this clinical population.
One of the aims of this therapy for Andrew was to reduce hospital admissions in BPD clients in response to over-representation of individuals presenting with BPD within inpatient populations. DBT was also chosen as people working in mental health settings can be easily trained in this therapy. It has also been shown to be effective over a one-year period. Andrew highlighted that although the differences between models to treat BPD are not huge, DBT may be more effective for behaviours such as self-harm that can occur in this population. The data collected shows a drop in hospital admissions however longitudinal studies are required in the future. Andrew says that from his point of view he believes it is working.
Simon Jakes spoke next about an inpatient program called Birunji for young people aged 16-24. This program helps young people with their mental health, and a number of those attending have a BPD diagnosis. The program can run anywhere from one week to a year depending on their needs. DBT was also chosen here because of its effectiveness with addressing deliberate self-harm. A semi-structured interview was conducted with six young people regarding their thoughts on DBT. A number of them found it useful in helping to understand their feelings. Others did not like the group work aspect of this therapy. Further research can look at the longitudinal outcomes and tailoring the therapy to the needs of young people.
Andrew then spoke again on behalf of his colleague Claudia Mendez. He discussed the implementation of an eight-week program for carers of consumers participating in their Liverpool and Fairfield DBT program. This program is important, as carers are a vital part of the treatment team for an individual living with BPD. It is also important that the carer keeps an eye on their own mental health, as living with a partner who experience BPD can be very stressful. Andrew discussed that research has found that if a carer is only presented with psycho-education it can actually lead to to higher levels of perceived carer burden in the individual. Studies of this nature highlight the need for carers to receive extra assistance and support. The program had a low drop out rate and will hopefully continue into the future.