A Look 'Behind the Curtains' at Personality Disorder and Mental Health Social Work: Perspectives and Expectations of Service Users and Practitioners

Abstract

This research project aims to explore service user and mental health social workers’ (MHSW) perspectives and experiences of practice in the area of personality disorder. It seeks to answer three research questions: how service users and MHSWs understand personality disorder, how they understand MHSW practice and how practice in this area might be better informed. The study’s attention to the experiences and perspectives of both groups sets the research within the interpretivist paradigm and relies on a relativist ontology, subjectivist epistemology and inductive, qualitative methodology. The involvement of both groups means that this project makes an original contribution to MHSW research and practice. Constructivist grounded theory (CGT) has been used to generate a conceptual, theoretical analysis. The research was divided into two phases. Phase 1 involved ten semi-structured interviews with ten service users from a community service for people with personality disorder. This data was analysed before Phase 2 began, comprising twelve semi-structured interviews with twelve MHSWs from three regions of England. NVivo 7 was used to analyse the data in and across case. The analysis identified participants’ understanding of personality disorder, mental health social work practice and how this practice might be better informed. The analysis was supplemented by documentary analysis of policies relevant to personality disorder and MHSW. The findings suggest that traumatic experience impacts on the lens through which the person views self and others. Distress can be overwhelming, lead to extreme and unsafe behaviours, which reinforce disconnection from self and others. In supporting a relationship between personality disorder and traumatic experience, this study suggests the relevance of mental health social work (MHSW) to personality disorder. The findings suggest that more humane, empathic responses are required. Practice founded on understanding the impact of traumatic experience and the ways in which the individual might be trying to cope with their distress. The findings reveal the importance of MHSWs’ relational skills and interventions that offer practical support, encouragement and effective liaison with others. Through more caring, protective bonds and broad social supports MHSW might empower individuals’ response to traumatic experience. The findings raise implications for MHSW and mental health professionals more generally. The findings also indicate that practice would be better informed by greater knowledge and understanding of the person and the diagnosis; the provision of feedback to the person; modelling; greater transparency and consistency; support for the person’s social and family network, and more practical support. This project makes an original contribution to knowledge about personality disorder and to MHSW knowledge and practice in this area.