1. Personality Disorder Training; what is the point?
Andy Williams, Consultant Psychiatrist in Psychotherapy
Sue Wallace, Sen. Adult Psychotherapist, Mandy Carruth, Nurse Therapist
Personality Disorder and Homelessness Team
NHS Greater Glasgow and Clyde

2. Background
Almost 8 years experience of PD training in homeless services in Glasgow
Recent experience of training in prisons
What have we learned about how to do it?
What level of training is right?
What style of training is right?

3. PD and Homelessness Team the context
Psychodynamic psychotherapy – MBT
Small resource
City-wide
Remit to work across agencies
Emphasis on consultation and TRAINING

4. PD and Homelessness Team Expectations of what training could achieve
Reduce repeat homelessness !
Give staff
Tools
Strategies
to manage/ cope with difficult behaviour

5. What are requests for training about?
feeling of being overwhelmed by the work
interest to know more about the subject
stress/ anxiety in the organisation
not knowing how best to support someone
someone else might know what to do – an expert?

6. What are requests for training about?
feeling of being overwhelmed by the work
interest to know more about the subject
“My manager told me to come”
stress/ anxiety in the organisation
not knowing how best to support someone
someone else might know what to do – an expert?

7. What are we trying to achieve?
Change in:
knowledge
skills
attitude

8. practice makes perfect…
2006 – 2014
8-10 training days/ year
Total of 1,331 staff trained

9. in the beginning……

10. transference and countertransference
reflective practice
Can people think more about what is going on for the person with personality disorder?
and for themselves,
and their teams?
transference and countertransference
splitting

11. Can people keep in mind the possible origins of “difficult” behaviour?
genes
temperament
Can people keep in mind the possible origins of “difficult” behaviour?
and think about development/
early attachment
attachment

12. Can people shift to a more empathic position?
curiosity
Can people shift to a more empathic position?
empathy

13. Draw a picture

18. Elements in the 1 day Introduction to PD training
A lot about attachment and the relationship
A fair bit of thinking about scenarios
A wee bit on definitions and categories of personality disorder
Group work
Controversies
Complexity
Discussion

22. Could we adapt this for prison settings?
Thanks to:
Dr Alex Quinn, Cons Forensic Psychiatrist NHS Lothian
Dr Jo Brown, SpR in Forensic Psychiatry, NHS Lothian

23. Personality Disorder Training for SPS and prison healthcare staff
10 training days over a 6 month period from Jan to June 2014
Barlinnie 4 days
Greenock 2 days
Low Moss 4 days
Total of 186 staff

24. Write on a picture

25. What was different? more time on antisocial/ psychopathy
paranoid and schizoid also included
more forensic cases/ issues discussed
more about criminality and responsibility
humility
humour

26. More time on Empathy and distinguishing from Collusion
Can empathise without agreeing
Not the same as taking side of prisoner
Discuss concerns about “looking soft” in front of colleagues
Concerns about being “taken in”

27. Managing BPD Cold/ hostile Empathic consistent inconsistent
Key Approaches
Cold/ hostile
Empathic
inconsistent
consistent
Un-boundaried
boundaried

28. some graphs….
Question 1: How well did the learning event meet your aims/ objectives?
Question 2: How relevant was the content of the event to your work?
Question 3: Please rate the presentation of information
Question 4: Suitability of audio/visual aids (eg slides, video)
Question 5: Suitability of venue

30. How much of the event did you find interesting?
161 18

31. Was the event……. 11
163 6

32. Was the speed of the day….1
170 7

33. General Comments
‘Useful reference for dealing with our client group within the prison setting.
Emphasised the quality needed by staff for open empathic communication’
‘Excellent – thoroughly enjoyed the day and the insight into disorders which will help in my day to day dealings with some individuals in Barlinnie’
‘ I now have an increased awareness of PD. I can see the benefit to me in my role’
‘ Gave me a good insight into personality disorders, how to identify it in my job and measures I can put in place to help me work with patients’
‘ Fascinating and very helpful. Wish I’d done this 20 years ago’

34. Suggestions for future events
‘Over 2 days to allow more time for discussion’
‘Make this course compulsive for all staff who have prisoner contact’
‘Follow up training in venue away from workplace’
‘This should be part of prison officers initial training at the SPS college.
Very interesting and enjoyable’
‘Would like more training to develop my skills’
‘More in depth awareness and range of interventions’

35. One thing I will change about my practice is…
‘ Show more empathy’
‘ Try to be more understanding now I know more about PD’
‘ Be more understanding of people’s behaviours without judging’
‘ In future this will raise question marks as to the reasoning behind
someone’s behaviour instead of assuming they are just trying to be
disruptive’
‘Using suggestions during course when dealing with prisoners
displaying PD traits’

36. Someone with Borderline Personality has a very mild disorder

37. There is no successful treatment for BPD

38. People with PD cannot change

39. People with PD can live successful lives

40. Someone with PD can be detained under MHA

41. Medication is the main treatment for PD

42. I feel confident I could recognise that someone has a PD
AGREE
DISAGREE

43. I feel confident that I have the skills to work with someone with PD
AGREE
DISAGREE

44. People with PD are less deserving than people with other mental health problems
AGREE
DISAGREE

45. People with PD always have control over their behaviour
AGREE
DISAGREE

46. There is nothing I can do to help someone with PD
AGREE
DISAGREE

47. some questions How much training is enough?
1 day introduction?
2 day MBT skills?
More?
How to sustain interest/ attitude change
Service user involvement

48. Research Project
“Tricky interactions”: exploring mental health staff responses to stressful interpersonal sequences following mentalizing skills training
2014/15