Multidisciplinary team perspectives of borderline personality disorder and clinicians’ experiences of support

Fernandes, Nina and Hodge, Suzanne (2021) Multidisciplinary team perspectives of borderline personality disorder and clinicians’ experiences of support. PhD thesis, Lancaster University.

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Abstract

This thesis explores clinicians’ experiences of working with individuals diagnosed with Borderline Personality Disorder (BPD) and psychiatrists’ perspectives of supporting clinicians in their work with this client group. It includes a systematic literature review, research paper, critical appraisal, and an ethics section. The review uses thematic synthesis involving a three-step iterative process of synthesising clinician responses from 10 included papers. Four themes were derived from the synthesis which included, BPD: a polarising diagnosis, difficult patient status, caught up in the whirlwind, and when things go well. Clinicians can find their work with clients diagnosed with BPD challenging and have mixed responses to this diagnosis. The main factors perpetuating these experiences include workload pressure, limited experience of working with BPD, and when negative attitudes are ingrained in service cultures. Understanding the impact of childhood trauma which may lead to emotional distress, and support from the wider multidisciplinary team (MDT), were felt to enable constructive experiences with this client group. This highlighted the need to further understand how MDTs are led and supported in this work. The research paper explores psychiatrists’ experiences of leading and managing MDTs in their work with individuals with a BPD diagnosis. Ten psychiatrists were recruited online. Data were collected using semistructured interviews and analysed using Interpretative Phenomenological Analysis. Four themes were developed which included, MDTs are stress tested by this work, teams require scaffolding to work effectively, the burden of responsibility, and protect yourself. Participant responses indicated that systemic pressures affect MDTs. Reflective practice and training can improve service delivery. The critical appraisal discusses the wider practical, methodological, and ethical issues in which this research paper is contextualised. This thesis illuminates the need to understand clinicians within the context of their work and the client beyond their diagnosis.