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The present study aimed to investigate adolescents’ experiences of a therapeutic inpatient service utilising mentalization-based treatment (MBT) for borderline personality disorder (BPD) features, including deliberate self-harm. A qualitative research approach was chosen and eight adolescents were interviewed on their experiences. Interviews were analysed using interpretative phenomenological analysis (IPA; Smith, Flowers & Larkin, 2009). The analysis resulted in five superordinate themes and 17 corresponding subordinate themes. Adolescents described having felt uncontained, uncontainable and misunderstood, particularly prior to their admission. They talked about a process of seeking containment from others which in some cases led to their admission. Participants described feeling contained and understood in the inpatient service and developing a healthier relationship with self and others. Finally, they talked about their recovery as a long and challenging journey and expressed hope for the future. The study concluded that therapeutic inpatient treatment utilising MBT was experienced as beneficial by adolescents, though methodological limitations were acknowledged. Clinical implications were drawn and recommendations for future research were made.

The objective of this study was to explore personal experiences of change of people diagnosed with borderline personality disorder (BPD) who had partaken in psychological therapy. The aim was to develop the first model of change grounded in service user experience so that this could inform recovery-oriented practice in relation to this client group. A constructivist grounded theory design was chosen. Eight people with a diagnosis of BPD who had completed group-based therapy programmes or were currently attending a peer support group were interviewed about their experiences of change using a semi-structured, open-ended format. An initial model was developed and refined through triangulation with three published accounts of experiences of change in the context of a BPD diagnosis. ‘Discovering “new ways of being” in interpersonal space’ was conceptualised as the core process underpinning pertinent activities and experiences relating to change in people diagnosed with BPD. This interactive, relational process was facilitated in environments that were felt to be both containing and open to conflict. It involved increasing levels of self-disclosure, information exchange, exploration of mental states, experimentation with new behaviours and the consolidation of new ways of being. The core process appeared to extend beyond the therapeutic setting if supported through a relationship with a secure base. Regardless of therapeutic allegiance, effective interventions for people diagnosed with BPD might share a common core change process. Further research is required into change processes in the context of individual psychological therapies and negative therapeutic experiences.

Dropout from therapy for personality disorder (PD) represents a clinically-important but poorly understood phenomenon in the existing literature. The present grounded theory study explores the experiences of clients with PD, and their therapists, of treatment dropout from a National Health Service outpatient psychotherapy service, specialising in psychodynamic interventions for PD. Pre-therapy questionnaires for 20 clients were initially reviewed to generate hypotheses about the differences between treatment dropouts and completers, before a focus group was conducted with six therapists to explore their beliefs about and experiences of client dropout. Finally, six individual interviews were conducted with clients with PD, five of whom had dropped out from therapy at the host service. The final model highlighted the importance of clients’ treatment expectations, how they perceived their therapist’s behaviour, and their interpersonal history in making decisions about whether to stay in or drop out of therapy. The impact of therapy endings upon clients is also discussed, as well as therapists’ beliefs about managing complex clients, both individually and within a team, under current financial and clinical pressures. The findings are then discussed in relation to existing theory and research, and the clinical implications and limitations of the study are presented.

A literature review in Section A reviews the conceptual and empirical literature with regard to the usefulness and challenges inherent in applying recovery approaches in secure services, with a particular focus on women with a diagnosis of personality disorder. Section B. Background: Some studies have suggested that recovery approaches could be facilitated in secure mental health services despite a number of inherent tensions. However, none have explored if this applies to women with a diagnosis of personality disorder in secure care. A group whose needs have historically been overlooked, and can present with complex care-seeking behaviours. Aims. To explore how staff working with these women understand and apply recovery approaches in secure units. Method. Eleven multidisciplinary staff members working in a medium-secure unit in the UK participated in in-depth interviews. The data was analysed using grounded theory. Results. A preliminary model was generated, which comprised of five categories: secure base, balancing tensions, therapeutic relationship, initiating recovery, and nurturing recovery. These appeared to interact and influence each other throughout the recovery process. Conclusions. Staff are required to continually balance a number of tensions and as such they need a secure base from which to explore the service-users’ unique recovery process through the medium of collaborative therapeutic relationships. Staff sharing a recovery ethos that is embedded in the culture of a conducive environment, and is supported by supervision and teamwork, fosters the actualisation of recovery principles of empowerment, identity formation, and hope. Section C provides a critical appraisal of the study as well as a personal reflection on what was learnt through the process of the conducting the study.