Section 1. Literature Review. Methodological limitations in the existing research are discussed and future research ideas are proposed to enable a more holistic understanding of direct care staff's experiences.;Section 2. Research Report. The aim was to explore the experiences of staff who have worked with learning disabled patients who also have a diagnosed borderline personality disorder. A free association narrative interview approach was used to analyse the accounts of eight direct care staff (Hollway and Jefferson, 2000). Working with patients who have a learning disability and a diagnosed borderline personality disorder is emotionally demanding. Participants did not appear comfortable in sharing their personal emotional experiences. It was thought this was because these were very painful and staff were concerned they would be criticised for voicing negative feelings about these patients. Staff appeared to manage their painful emotional experiences of their work by using a number of psychological defence mechanisms. These included projecting and expressing their negative feelings onto the organisation, and/or by trying to forget and repress these negative experiences. Organisational factors can be problematic and need to be addressed to reduce the obstacles staff experience in their work with patients who have a learning disability and also a borderline personality disorder. However, when staff comment upon these organisational factors they may also be indirectly expressing the emotional impact these patients are having upon them. Once the organisational factors have been addressed staff may begin to feel more supported and safe enough to explore the painful emotional reactions they have experienced in their work with their patients without the fear of being criticised by others.

Background: Patients with borderline personality disorder represent a large group in healthcare who are struggling with painful emotions in life. Caring should be based on strengthening health processes by focusing on the patients, but research made by the patient's perspective has shown that this population rather felt that their health processes was counteracted, than promoted. The patients felt that the nurses displayed a negative attitude towards them. Attitudes are defined as a system of values, emotions and actions towards others.   Aim: the purpose of this study was to highlight the attitudes and experiences of nurses towards caring for people with borderline personality disorder   Methods: A study on the literature based on nine scientific papers was performed. The articles have been analyzed, systematically coded and compiled into a new unit.   Results: This study shows that nurses have an overall negative attitude towards patients with borderline personality disorder. Three main categories emerged, which was lack of knowledge, difficult patients and experiences influence. The nurses expressed the lack of knowledge as a feeling of not being competent enough to provide the right care and because of the fact that they had little faith in the care options that existed. Difficult patients was the biggest theme which showed that patients were seen as strong, dangerous ruthless forces that evokes powerlessness among nurses. Something that was seen as consistent throughout the study was that the patients were seen as dishonest and manipulative. The third main theme ”experiences influence” showed that experiences affects and touches the nurse that then contributes to the selection of treatment strategies.   Discussions: It appears that there is a gap between nurses' attitudes and the needs of patients resulting in health suffering. This is discussed by Katie Erikson's theory of care suffering from nursing science theory of health and care, patients 'and nurses' views on health promotion.   Keywords: Borderline personality disorder, experiences, attitudes, nursing, nurse, nurses.

Background: People with Emotional Instable Personality (EIP) have a high comorbidity with other mental disorders and a high suicide rate. Previous research has revealed negative attitudes, in the society, toward people with EIP. They are often seen as manipulative, hard to understand and temperamental. Research has shown that this view also exists among health care professionals, who often have negative attitudes and show less empathy for patients with EIP Aim: The purpose of this study was to identify nursing interventions that can promote the quality of life for people with EIP. Method: Systematic literature review was used as a method. Thirty articles were selected for the study and these were sought in Chinal, PubMed and PsycINFO. Analysis and interpretation was done according to qualitative content analysis. Results: Five main categories were identified: Supporting components of caring; Including the patient in the care; Supportive care; Supporting activities and therapies; Supportive care interventions in inpatient care Conclusions: There is a need for more knowledge and greater understanding of people with EIP, in the society as well as in mental health services, in order to enable attitude changes and reduce the risk of further suffering. It is also important for healthcare professionals  to strive for continuity in the care of people with EIP. Patients should also be involved in their own care. It is also important to take a patient's perspective and respond to patients based on their individual needs.

This essay will analyze the protagonist of Arthur Miller’s, Death of a Salesman, Willy Loman, from a psychoanalytical perspective. The purpose is to establish the reason for his suicide. The thesis is that Willy Loman seems to have developed a narcissistic and borderline personality disorder and as a consequence his mentality was affected and that led him to commit suicide. Willy Loman is a self-centered man who has an obsession with success both as a salesman but also as a husband and a father, in such a way that his mental health is questioned. This suggests that his final decision to commit suicide has been affected by some type of mental disorder that derives from his neuroses. Therefore, Willy Loman’s behavior will be investigated by using Freud’s psychoanalytical theory of neuroses and mental disorders.

This study examined the empirical relationship between narcissism and self-esteem in an attempt to evaluate competing conceptualizations of narcissism. Participants were 236 children (mean age 11.3 years) in the fourth through eighth grades. Counter to earlier conceptions, which characterized narcissism as very high self-esteem, narcissism and self-esteem were slightly negatively correlated. Also, narcissism predicted several adjustment variables, including aggression. None of these relationships was mediated by self-esteem. Lastly, self-esteem moderated the relationship between narcissism and aggression in boys. Taken together, these lines of evidence point to a new conceptualization of narcissism, modeled after self-discrepancy theory, in which narcissism is conceptualized as grandiosity in the ideal self. Implications of this proposal and directions for future research are discussed. / by Rachel Evans. / Thesis (M.A.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.

Background: During an age of fiscal constraint and increasing pressure to provide timely access to effective, efficient and evidence based care, there is an increased need for research to develop empirically based prevention and intervention strategies for complex psychological difficulties which often present during childhood and adolescence. Child and Adolescent Mental Health Services (CAMHS) are under significant pressure to deliver timely access to services, with demand frequently outstripping capacity to deliver. These challenges have highlighted the need for services to ensure that planning supports continued improvement in quality and delivers the best possible outcomes for service users. Systematic Review: A systematic review of the literature on the efficacy of group based interventions for adolescents with features or a diagnosis of Borderline Personality Disorder (BPD) was conducted. Seven articles met the inclusion criteria and underwent detailed quality analysis. All included studies reported a significant improvement in psychopathology and symptoms of distress as well as an improvement in quality of life for both group based interventions and treatment as usual. Overall, the results hold promise for current work with adolescents with BPD and highlight the importance for future research in this developing area. However, more rigorous research is required to identify the active ingredients of treatments for BPD in adolescents with a view to developing standardised treatment protocols. Empirical Study: A Delphi study was conducted to explore perceptions on the relevance, practicalities, importance and feasibility of implementing nationally agreed CAMHS referral criteria from the perspective of clinicians working in CAMHS in the North of Scotland. In addition, the study aimed to explore and gain consensus on possible factors which support clinicians working in specialist services. A three round electronic Delphi survey, an iterative structured process used to gather information and gain group consensus, was completed by twenty-eight clinicians working in CAMHS. Eight open ended questions in Round 1, were analysed using content analyses resulting in ninety-eight statements to be rated by the same group of clinicians in Round 2 and fifteen statements in Round 3. Of the ninety-eight statements, eighty-four reached consensus. Results indicate that the guidelines are viewed by many clinicians as both acceptable and important, however, implementation of the guidelines can present services with significant challenges and have highlighted the importance of services having the correct infrastructure before it is possible to implement the referral criteria in a consistent and meaningful way.

Made available in DSpace on 2015-03-05T19:35:30Z (GMT). No. of bitstreams: 0 Previous issue date: 7 / Nenhuma / Essa Dissertação de Mestrado em Psicologia Clínica focalizou os vínculos afetivos de adolescentes com indicadores de organização de personalidade borderline com seus pais ou cuidadores primários. Foi realizado um estudo qualitativo, baseado em Estudos de Casos Múltiplos. Buscou-se caracterizar e analisar os vínculos afetivos estabelecidos entre estes adolescentes e seus pais, com base em uma leitura psicanalítica. Este volume inclui o relatório da pesquisa realizada, e dois artigos científicos: um de revisão crítica da literatura, e o outro empírico, com a apresentação e discussão dos resultados do estudo. A partir da análise das entrevistas e instrumentos utilizados, foi possível constatar, como aspectos principais, as fragilidades e inconsistências nos vínculos afetivos e histórias de vida permeadas por vivências e representações de abandono, negligência e falta de investimento emocional por parte das figuras parentais. Aspectos transgeracionais apareceram com destaque nas dinâmicas destas famílias, repercu

Borderline Personlighetstörning är en psykiatrisk diagnos som definieras genom symtom som bristande impulskontroll, relationsproblem och självskadeproblem.Flera av dessa symtom är av den karaktären att de förorsakar beteenden som gör att möjligheten till att ge en god omvårdnad försvåras. Syftet med litteraturstudien var att beskriva sjuksköterskors attityder och upplevelser av att vårda patienter som lider av diagnosen BPS.Resultatet analyserades utifrån Evans (2003) modell. Studien har visat vilka utmaningar sjuksköterskan upplever i mötet med patienter med BPS när det gäller relation och omvårdnad.Sjuksköterskorna beskriver negativa attityder och upplevelser i arbetet med patienter med BPS. . Vidare har det framkommit att sjuksköterskorna har föreställningar om egenskaper av farlighet och manipulation när det gäller patienter med BPS. Ett sätt att hantera de svårigheter som finns i omvårdnadsarbetet med patientgruppen har varit att använda sig av avståndstagande från sjuksköterskornas sida, visar studien. Resultatet pekar även på att sjuksköterskorna anser att patienter med BPS har större ansvar för sitt beteende jämfört med andra patientgrupper.Sjuksköterskorna känner dock professionellt ansvar för patientgruppen och upplever en viss optimism när de gäller denna utmanande patientgrupp.För att kunna ge god omvårdnad till patienter med BPS bör sjuksköterskan ha stöd i sin professionalitet i form av behöver ett sammansvetsat och stödjande team, realistiska och tydliga mål, adekvat utbildning och fortlöpande handledning. / Program: Sjuksköterskeutbildning

Clientes com Transtorno de Personalidade Borderline apresentam um alto índice de abandono de terapia. Entender o que ocorre durante as sessões entre terapeuta e cliente com este tipo de transtorno de personalidade pode contribuir para evitar futuros equívocos ou falhas na relação terapêutica, aumentando as chances de continuidade do processo terapêutico e diminuindo a probabilidade de abandono da terapia. O presente estudo teve como objetivo identificar as variáveis que estão relacionadas ao abandono de um caso de Transtorno de Personalidade Borderline. Participou do estudo uma terapeuta de orientação analítico-comportamental, com 12 anos de experiência clínica e uma cliente com 30 anos de idade, casada, sem filhos e com escolaridade superior completo. Um total de 13 sessões foi gravado em áudio, transcrito e categorizado segundo o Sistema Multidimensional para Categorização de Comportamentos da Interação Terapêutica. Foi feita análise sequencial de atraso (Lag sequential analysis). As sessões que compuseram os dados deste estudo foram entre a 9ª e a 22ª sessões, embora a 14ª sessão tenha sido excluída da análise de dados por ter sido uma sessão de casal. Os resultados mostraram que as categorias da terapeuta de maior porcentagem de ocorrência foram Facilitação, Solicitação de Relato e Empatia e as menos frequentes foram, Solicitação de Reflexão\", Aprovação e Recomendação. Reprovação foi a categoria que teve a menor frequência entre as demais categorias da terapeuta. Embora a categoria Interpretação tenha ocorrido em baixa frequência, sua duração foi grande. As categorias de maior porcentagem da cliente foram Relato e Estabelecimento de Relações entre Eventos. E as de menor porcentagem de ocorrência foram: Solicitação, Concordância, Oposição e Melhora. A categoria Metas não ocorreu nenhuma vez. Ao longo das sessões, foi observado um declínio na porcentagem de Estabelecimento de Relações entre Eventos e um aumento em Relato, no que se refere às categorias da cliente. Ao mesmo tempo, foi observada uma diminuição das categorias Empatia, Solicitação de Reflexão e Interpretação da terapeuta. As sequências que mais ocorreram foram Relato\" seguido por Facilitação\" e Facilitação\" seguida por Relato\". O abandono da terapia pareceu estar relacionado a diversos fatores: a) perda de oportunidades de aprovar e solicitar reflexão e interpretar, b) não dar atenção a relatos sobre queixas de doenças, exercendo função de invalidação, c) férias prolongadas da terapeuta e d) não flexibilidade da terapeuta em fazer mais uma sessão domiciliar em um momento de crise, repetindo assim, um comportamento de invalidação / Clients suffering from Borderline Personality Disorder show a high dropout rate in psychotherapy. The understanding of what occurs during the sessions between therapist and client suffering from this type of personality disorder may contribute to prevent future errors and failures, increasing chances of completing the therapeutic process and reducing drop-out probability. The current study had the objective of identifying the variables related to the drop-out in a case of Borderline Personality Disorder. Participated a female behavior-analytic therapist, with 12 years of clinical experience and a female client, 30 years old, married, no children, with a college degree. 13 complete sessions were recorded in video, transcribed and categorized according to the Multidimensional System for Categorization of Behaviors in Therapeutic Interaction. A lag sequential analysis was carried out. Data of this study refer to the 9th through the 22nd sessions, although the 14th session was excluded, since it was a couple session. Outcomes showed that the therapists categories in higher percentages were `Facilitation`, `Request of Report` and `Empathy` and the less frequent percentages were `Request of Reflection`, `Approval` and `Recommendation`. `Disapproval` was the therapists category appearing with lower frequency. Although `Interpretation` occurred in low frequency, it had a long duration. The clients categories with higher percentages were `Report` and `Establishment of Relationship between Events`. The lower percentages of occurrences were: `Request`, `Agreement`, `Opposition` and `Improvement`. The category `Aims` did not occur at any time. Throughout the sessions a decrease in percentage of the client\'s categories `Establishment of Relationship between Events` and an increase in \'Report\' were observed. At the same time a decrease in the therapists categories `Empathy`, `Request for Reflection` and `Interpretation` was noted. Sequences which occurred more frequently were `Report` followed by `Facilitation` and `Facilitation` followed by `Report`. The therapy drop-out seemed to be related to several factors: a) loss of opportunities by the therapist to approve, to request reflection and to interpret; b) lack of attention to reports on complaints of diseases, having an invalidation effect; c) therapists extended vacation and d) therapists refusal to attend an additional home session, in a critical moment, thus repeating the invalidation

Doctor of Health Science / The public mental health setting wherein clinicians work with clients diagnosed with borderline personality disorder (BPD) provides a continual challenge for clinicians. For many decades a pervasive therapeutic pessimism has surrounded any discussions of attempts to work with clients with BPD with this population being viewed as ‘too difficult’ and ‘impossible to work with’. This pessimism and the ensuing counter therapeutic responses have been well documented in the psychiatric literature. The development of treatments such as dialectical behaviour therapy (DBT), a cognitive-behavioural therapy, for BPD has provided a basis for therapy for which there is increasing evidence of successful outcomes. Despite this evidence, the pervasive pessimism has been slow to lift. A limited literature explores attempts to positively influence clinician responses to this clientele. Within the public mental health service in which this research is based, DBT is well-established as a therapeutic modality. In the course of providing training, consultation and supervision for parts of this service, anecdotal evidence emerged suggesting that the impact of practising as a DBT therapist was greater than anticipated and DBT may provide a tool for facilitating a positive change in clinician responses. Given that this perception is not described in the literature it was appropriate to begin research in this area employing a qualitative methodology. This research explored the experience and impact upon mental health clinicians in a public mental health service undertaking training in DBT and practicing as DBT therapists. In-depth, semi structured interviews were conducted in July 2005 with clinicians practising as DBT therapists. Data analysis revealed a marked shift in perspective from ‘management to treatment’. Participants described positive professional and personal impacts of training and practising as DBT therapists. An enhanced capacity for self-awareness and ‘living life to the full’ was described by a number of participants. This initial research suggests that the practice of DBT by clinicians can generate a positive shift in both personal and professional identities that translates into a more optimistic and humanistic approach to clients diagnosed with BPD. Such a change may represent a significant challenge to the prevailing mental health discourse and practice