Diagnosis and therapeutic relationships: the perspectives of service users with a Borderline Personality Disorder diagnosis

Green, Sophie and Smith, Ian and Hodge, Suzanne and Kenworthy, Emma (2021) Diagnosis and therapeutic relationships: the perspectives of service users with a Borderline Personality Disorder diagnosis. PhD thesis, Lancaster University.

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Abstract

This thesis begins with a literature review exploring how individuals who have a diagnosis of Borderline Personality Disorder (BPD) experience the therapeutic relationship during psychological therapy. A systematic literature search identified 15 papers which were synthesised using a meta-ethnographic approach. Three third order themes emerged; valuing a therapeutic relationship, building a connection (based on trust), and coming together to navigate the therapeutic relationship. These findings highlight the importance of the therapeutic relationship across psychological therapies for people with a BPD diagnosis and that positive therapeutic relationships are needed for successful therapy. Clinical implications are discussed. The research paper explores service-user perceptions of how receiving a diagnosis of BPD affects wellbeing. Nine participants were interviewed, and data were analysed using a constructivist grounded theory method. A model was developed which highlighted two key processes that influenced participants’ wellbeing. Firstly, the way in which the diagnosis was communicated, as this laid foundations for participants’ perceptions of the diagnosis. Secondly, participants’ experiences of the perceived advantages and disadvantages of living with the diagnosis, which included the responses of services, the influence on participants’ social relationships and impact of stigma. The findings are discussed in relation to the existing literature surrounding mental health diagnosis and contributes by highlighting the specific processes and mechanisms which occur for people who receive a diagnosis of BPD. From the developed model clinical implications and areas of future research are proposed. The critical appraisal focuses on the findings of the empirical paper and processes of carrying out a grounded theory investigation. Issues around conducting research during the Covid-19 pandemic are also considered.