Academic journal article New Zealand Journal of Psychology

A Qualitative Investigation of the Clinician Experience of Working with Borderline Personality Disorder

Academic journal article New Zealand Journal of Psychology

A Qualitative Investigation of the Clinician Experience of Working with Borderline Personality Disorder

Article excerpt

The current research provided opportunity for 140 clinicians across emergency medicine and mental health service settings in Australia and New Zealand to make comment about their experiences in working with patients diagnosed with borderline personality disorder (BPD), in order to allow for some illustration of the difficulties found within the literature with regard to negative attitudes towards this patient group. Thematic analysis conducted on the qualitative responses revealed four key themes: 1. BPD patients generate an uncomfortable personal response in the clinicians, 2. specific characteristics of BPD that contribute to negative clinician and health service response, 3. inadequacies of the health system in addressing BPD patient needs, and 4. techniques and strategies needed to improve service provision with BPD. This investigation gives illustration to the key difficulties that clinicians have in working with patients diagnosed with BPD and suggests that interpersonal and system difficulties may have altered the provision of service that is available to this patient group.

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Of recent times, much research has been conducted to examine professional attitudes towards patients with borderline personality disorder (BPD). A review of some of these studies reveals a consistent theme that the attitudes of health professionals towards patients diagnosed with this complex disorder tend to be negative and derogatory (e.g., Commons Treloar & Lewis, 2008; Bowers & Allan, 2006; Deans & Meocevic, 2006; Potter 2006). A recent quantitative study of health professionals across emergency medicine and mental health service settings however revealed that there appeared to be some discrepancies across clinicians working in these two service settings, with emergency medicine clinicians reporting more negative attitudes towards BPD patients than their mental health counterparts (p<.001 ) (Commons Treloar & Lewis, 2008). Furthermore, gender and discipline specific differences in attitude ratings were found, with female staff reporting a more positive attitude towards this patient group (p=.02), and examination of participant attitudes across the three occupation areas of nursing (general and psychiatric registration), allied health (psychologists, social workers, and occupational therapists), and medical fields (medical registrars and officers, and psychiatric registrars and psychiatrists) revealed a significant difference between the attitude ratings recorded (p = .04), with clinicians registered as allied health professionals demonstrated significantly more positive attitude ratings towards patients with BPD than the other two occupation areas (Commons Treloar & Lewis, 2008). Although gender, service setting, and discipline of the clinicians appears to be of some influence to the generation of more positive or more negative clinician attitudes, a more enriched illustration of the difficulties perceived by health professionals in their work with patients diagnosed with BPD, which may in fact contribute to the recorded attitude ratings of emergency medicine and mental health clinicians, was not a focus however in the current literature.

A review of the consumer literature also raises some concerns as to health professional attitudes towards patients with BPD. Many BPD patients that engage in self-harm, particularly those with repeated episodes, feel that the health professionals are not willing or interested in becoming involved in their psychotherapeutie treatment (National Collaborating Centre for Mental Health, 2004). Upon review of patient feedback, it becomes apparent that "service users describe contact with health services as often difficult, characterised by ignorance, negative attitudes and, sometimes, punitive behaviour" (National Collaborating Centre for Mental Health, 2004, p.28). Numerous studies have suggested that difficulties with clinician attitudes towards working with BPD remain constant, but until now an examination of why this may be, perhaps in regard to the limited health system resources or clinician knowledge available within the community, has not been completed. …

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