1. Consultation team longevity: Challenges and issues
Zoe Otter, Forensic Psychologist

2. Outline PiC Midlands DBT Timeline The DBT Team – PiC Midlands
Current consultation meeting arrangements
Consultation agenda
Consultation team agreements
Consultation challenges
Individual (team) impact
Positives of our consultation team
Future directions

3. Partnerships in Care - Midlands
Calverton Hill
2 Medium Secure wards for women with high levels of challenging behaviours and complex forensic histories
32 beds
1 Medium Secure female Learning Disability ward - 16 beds
1 Medium Secure male Learning Disability ward - 16 beds
Annesley House
Low Secure and Inpatient Rehabilitation including specialised High Dependency Unit
Women only with primary condition of mental illness and/or personality disorder
28 beds
Annesley House
Low Secure
Calverton Hill
Medium Secure

4. DBT timeline
2005
Began to introduce DBT to the organisation (Medium Secure)
2 trained therapists (Psychologists)
1 left & 4 attended DBT training (2 Psychologists, 1 Social Worker, 1 Mental Health Nurse)
2008
DBT programme well established at both Medium and Low Secure sites
3 trained therapists
4 attended DBT training (3 Psychologists, 1 Social Worker – Social Worker did not complete training, completed by psychologist)
2009
7 trained therapists (Psychologists)
2013/14
3 more nurses and four psychologists trained
2015/16
3 more staff trained – 1 psychologist, 2 nurses

5. Partnerships in Care Midlands
Dialectical Behaviour Therapy Team

6. Forensic Psychologist John Greenacre Staff Nurse Dr Nicola Sutton
LEAD
Zoe Otter
Forensic Psychologist
John Greenacre
Staff Nurse
Dr Nicola Sutton
Forensic Psychologist
Nathalie McPherson
Staff Nurse
Jess Townes
Acting Charge Nurse
Kristy Summers
Trainee Forensic Psychologist
Sarah Ashworth
Trainee Forensic Psychologist
Donna Harrison
Trainee Forensic Psychologist
Dr Natalie Brotherton
Principle Clinical Psychologist
Emily Goodrick
Charge Nurse

7. Consultation meeting arrangements
Weekly meetings
1 hour 12:30-13:30
Business meeting every 5th week
2 weeks: video conference between Annesley House and Calverton Hill
2 weeks: separate consultation meeting at both sites (aim: to encourage use of role-play/practise)

8. Consultation team meeting: Agenda
Mindfulness
Apologies and announcements
Reflections on the last meeting
Behaviour analysis and repair
Consultation questions
Skills group, referrals
Skills training
AOB

9. Consultation team agreements
Dialectical agreement
(no absolute truth, search for a synthesis by asking ‘what is being left out?)
Consultation-to-the-patient agreement
(to improve our own skills as a therapist, to not treat each other as fragile)
Consistency agreement
(accept diversity and change, we have different opinions)
Observing limits agreement
(observe our own limits and not judge or criticise the different limits of others)
Phenomenological empathy agreement
(no blaming, we are trying our best and want to improve)
Fallibility agreement
(we all make mistakes and must help each other to find a synthesis)

10. DBT Consultation Challenges
Establishing consultation
Training
New staff/changes in team
Non attendance
Consultation Challenges
Working in a dialectical way
Cross-site and cross-service working
Establishing consultation – in 2005 it was a relatively new intervention – diabolical behaviour therapy – sect!
Training – increasingly supported over the years but can be complex to organise and to support staff with
New staff/changes in the team – brings new dynamics and new approaches – new elephants (as well as positive opportunities for learning and renewed motivation)
Working in a dialectical way – practising what you preach! Is likely to be an indicator of the degree of support that is needed within individual therapy
Individual impact – an emotional rollercoaster between some strong negative feelings and some very positive feelings – also reflects individual therapy
(Time) commitments – understandably difficult for nursing staff but this has also improved over time and perhaps reflects the good organisational commitment to supporting DBT
Organisational commitment – currently the best it has been
Cross-site and cross-service working (Annesley House and Calverton Hill & DBT and ICFG)
Non-attendance – is an ongoing challenge
Individual (and team) impact
(Time) commitments
Organisational commitment

11. DBT therapist – individual (and team) impact
Feeling:
Alone
Energetic
Discouraged
Confident
Hopeless
Encouraged
Depressed
Supported
Frustrated
Competent
Angry
Valued
Incompetent
Undervalued
Unrealistic demands on self
These are just some of the emotional effects… DBT is also a huge time commitment, resource commitment, etc…

13. Consultation team: Observer tasks
Judgmental/non-compassionate comment is made
Consultation members are treated as fragile
Dialectic goes unresolved
Defensiveness arises, forgetting that we are all fallible
Non-mindfulness, doing two things at once
Solutions are given before the problem is assessed
Consultation-to-team intervening, rather than teaching

14. DBT Consultation Positives
(Previous) development of internal training
Supportive environment
Integration of new members of the team
Commitment
Consultation Positives
Positive outcome data
Flexibility
Strong support provided by everyone.
connection
Multidisciplinary team
Well established
Organisational commitment increased
Sharing practice

15. Further progress… Supporting each other with:
Consultation to the therapist
Following the consultation team agreements
Ongoing organisational support of staff training and facilitation by all disciplines involved
Consideration of individual and team accreditation in future
Research/publication of outcome data
Further conferences – sharing ideas and experiences
Consultation - Primary functions:
1) to keep the therapist in the therapeutic relationship (with the patient and the team)…(by cheerleading and support of the therapist)
2) to balance the therapist
3) to provide the context for the treatment (DBT = a transactional relationship between all borderline patients and therapists involved)