P.Johnson, Research & Development Manager M.Thomson, Research Practitioner

Calderstones Partnership NHS Foundation Trust provides learning disability services for clients with forensic risks requiring medium and low secure, and enhanced supported living environments. Calderstones has recently embarked on a major service development with a team of ten clinicians, from psychology and nursing levels, being assigned the task of completing an intensive training course in Dialectical Behaviour Therapy (DBT) and implementing it within the Trust.

 The participants were recruited from a cohort of 7 female clients; 2 from a medium secure ward, and 5 residing in the low secure. These women were identified by the DBT team to be included in the first wave of DBT.  The research gained full ethical permissions via IRAS at both Calderstones and North West (Preston) ethical committees.

 The primary aim of this qualitative research was to capture the experiences of female clients with learning disabilities and personality disorder undergoing DBT by using semi-structured 1:1 interviews.  Interviews were carried out by the research team, audio recorded and transcribed verbatim.  The research team worked in close partnership with the DBT team to ensure that this study did not hinder and/or compromise the women's DBT therapy.

The research team analysed the interview transcriptions with an interpretative phenomenological analysis (IPA) approach (Smith et al., 2009). By exploring each participant’s views in detail, it allowed for the generation of a rich understanding of the women's experiences in order to propose concepts to help understanding into how clients view and experience DBT. 6 main themes were identified......

Understanding DBT Two therapies at once Support to practice homework Our feelings about DBT Using DBT skills Suggestions for the future/ other services

Understanding DBT “The hardest part was not being able to self harm whilst on the course”. “So you recognize how happy, sad, angry, ashamed or afraid you are, so you’ve got to focus on how you are feeling, then only if you focus on how you are feeling will you be able to try and sort it out”.

Two therapies at once “Was hard to do 2 therapies at once. In the individual look at incidents and do a chain analysis and try and put the group skills into practice to try and handle it better”. “It’s quite good actually yes. Because it means you’re getting double the support”.

Support to practice homework “Because with me I’ve got a learning disability and I can hear things and see things but I don’t always register, it doesn’t always register with me, like NAME had been over, she’s been over a few times this week, or last, just to do me homework with me, and even when she’s gone, it’s gone”. “Cos on our homework it doesn’t give you clear information on what you want to do, what to do on the homework, just tells you what to do and I just don’t understand it. You have to write down clearly what you have to do”.

Our feelings about DBT “Before I did it I used to do lots of silly things. But now it helps me to relax and focus and be positive and things that I wanna do, and where I want to be in my life”. “Because it’s given us the skills to deal with everyday problems and past experiences and stuff”.

Using DBT skills “It involves skills and erm if you can’t change anything, there’s a problem on the ward, like last week I wanted to go to my room, and I couldn’t go to me room because there was an incident on the ward and I said to meself, oh well, I can’t go to me room, I can’t change anything, so I’ll sit there and wait patiently and that’s what I did. Now that’s one of the skills I used”. “non-acceptance, which is basically you’ve got to find a way so, if something happens you have to either accept it or not accept it. 9 times out of 10 we all don’t accept it, and we should be learning to accept it”.

Suggestions for the future/ other services “I think it will make things better if everybody knows about DBT, because they’ll understand more cos, like some staff in the room were looking at me strangely that other day cos I was doing one of me DBT skills”. “Yes, because what they’re doing on XXXXXXXX (Ward area) they’re getting one of the staff over to DBT on a Tuesday morning so they can learn what we do there. But that would be a good idea if one staff could go off here as well, because, when they’re over on the other ward, the staff are helping them to do it, but here they’re not”.

“me and one of the other girls who are doing it are meant to be going round with, to all the staff to erm, help em learn about DBT and what basically what it like for us to do it”. “Every time you do a DBT course it’s all different courses. Cos the one I do here it’s not the same as PREVIOUS PLACEMENT. “ I think they should not do the modules too quickly”

Copy of the session plan for clients prior to group Flexible timescales to meet the needs of the clients Create DBT environments on the ward for all MDT to embrace model DBT Model

Further training for staff teams to better engage DBT The first cohort in DBT to assist in staff training DBT Model

The research team would like to thank the women who took part in this study and allowed us to share with them their intimate experiences of their therapy journey. We were inspired by their courage and honesty.

Thank you for listening and any questions!

 Linehan, M. M. (1993). Cognitive behavioural treatment of borderline personality disorder. New York: Guilford Press.  Smith. J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: theory, method and research. London: Sage.