THE BRENCHLEY UNIT PERSONALITY DISORDERS COURSE
(Clinical treatment of Borderline Personality Disorder – KIMHS University of Kent Canterbury)
Background
Following our failed bid to attract NIMHE development monies we were invited to make application for funding to design, develop and deliver a multi agency training course according to the strict criteria laid down by the Institute. With established links with the University of Kent and Canterbury Christ Church we were well placed to provide such a training.
The Setting
The Brenchley Unit Personality Disorder Service includes a three-day-a-week Therapeutic Community programme offering intensive Group psychotherapeutic treatment for those people with a diagnosis of Severe or Borderline Personality Disorder. The unit is situated on the ground floor of The Courtyard in Pudding Lane, Maidstone.
The Community has the capacity to take up to 24 members for twelve months, bringing in new members from a weekly preparatory group as others leave the programme. The latter are encouraged to join a weekly “Leavers” group, while every effort is made to monitor those who for a variety of reasons drop out prematurely. It is the case that a significant number of dropouts return to complete their 12 months.
The service also provides supportive individual therapy to some clients who are unable or unavailable for the community programme.
There is considerable interest in the work of the unit and professionals in the field can arrange to visit for the day.
The unit offers placements to training nurses, doctors, psychotherapists and psychiatrists.
The Community meets on Tuesdays, Wednesdays and Fridays from 10am to 4pm and attendance at the full programme is for twelve months. The treatment programme is based on the therapeutic community models that have been developed at the Henderson Hospital and others. All the treatment takes place in set groups which includes the full community group, small therapy groups, Art therapy and Activity groups.
Course Intentions and Content
1) Course Content:
Areas for exploration will include:
· Aetiology including developmental models
· Assessment & Diagnosis
· Risk Assessment
· A Care Programme Approach
· Principles of Management
· Treatment Responses and their efficacy
· Self harming behaviours – attacks on the self
· Attitudes-positive and prejudiced
· The Social context
· Effective team work
· Staff Support
· Intra and Inter group dynamics
· Service Developments
Our current thinking seeks to include the varied perspectives of participants while wanting to foster the development of a shared if eclectic approach and the evolution of a common language for understanding, communicating about and responding to this client group. It is expected that such outcomes will arise out of the proper facilitation and interaction of the multi-professional, multi-agency group. We recognise that learning takes place at different points for different people and is only productive if it connects with previous learning and experience. Consequently, we will be most concerned to ensure ample opportunity for reflective and experiential learning. Essentially, we believe that the group itself is the learning/teaching resource and that all pertinent knowledge and competence reside there. Clearly, such a modality utilises the “virtual” multi-professional, multi-agency work group to foster improved team working back at the host agencies- part of the “cascading” intentions. Work-oriented and experiential group work promotes dialogic communication, free expression, equality of contribution and tolerance for conflict making for more robust and empowered team work.
The intended learning outcomes.
· To sharpen students’ skills in the recognition and assessment of severe personality disorder
· To facilitate an integrated inter-professional, inter-agency approach to the care and treatment of clients with SPD according to CPA principles
· To encourage the setting of realistic treatment goals based upon an increased knowledge of the aetiology and symptomatology of SPD
· To foster awareness of the impact of this client group on front line professionals and their need for ongoing supervision and support
· To enable appropriate referral on of this client group to specialised services where appropriate
· To enable students to develop reflective practice within the multi-disciplinary context through understanding others roles and the exploration and resolution of conflict in the clinical setting
· Ability to communicate effectively with professional colleagues from a variety of disciplines
· Ability to recognise and plan effectively for patients with SPD using enhanced CPA principles
· Ability to provide and receive support in a multi-disciplinary team environment
2) Staff:
Roger Davies; Caroline Burgess – Art Therapist, with contributions from Current Brenchley Unit service Users.
3) Organising Team:
Background in Education, Social work, Training and Staff Support.
Worked as Senior Manager in several Therapeutic Communities for adolescents before joining Adult MH field in 1999.
Group Analyst and Consultant Psychotherapist West Kent NHS & Social Care Trust.
Sewrvice Manager Brenchley Unit (PD Service).
Honorary Lecturer KIMHS University of Kent.
Background in psychiatry in NHS and Therapeutic Community work.
Specialises in Personality Disorder
Consultant Psychotherapist ; Acting Medical Director West Kent NHS & Social Care Trust.
Dr M Elena Oro Ph.D.
Background in Psychology and Counselling in the USA in various settings
Consultant Psychologist - Head of Older People, Primary Care
Psychology & Counselling Service West Kent NHS & Social Care Trust.
Dr. Georgia Lepper, PhD.
Georgia Lepper is a
Professional Member of the Society of Analytical
Psychology. As Lecturer in Psychotherapy at the University of Kent, she is
responsible for the development of training programmes for mental health
workers. She is an active researcher and supervises clinical psychotherapy
research students.
Co-ordinator, Psychotherapy
Group KIMHS
Kent Research and Development Centre
University of Kent, Canterbury.
James Copeland – Member Brenchley Unit Therapeutic Community
Lynva Gibbert - Member Brenchley Unit Therapeutic Community
4) Other features:
The course is distinguished by the extensive experience of the teaching contributors and the Therapeutic Community setting.
The Brenchley Unit Personality Disorders Service has recently won the NHS award for outstanding work in the MH field – Southern Sector and went on to secure the National award.
The University of Kent Canterbury accredit the course. Students wishing to submit a 3.000 word assignment will be awarded 30 credits.
See attached Assessment requirements from University.
Future Intentions:
The “pilot” year was most successful and the second year 2005-2006 is currently in full swing with a full compliment of 24 students again from as diverse a field as previously. Again two “Experts by Experience” are attending the sessions as full participants. We have had to charge £300 for the course this year to cover costs and this will increase to £500 for the next year 2006-2007. At this rate the course should become self funding although there is considerable anxiety that we will have enough interestat this price.
There are several encouraging if embryonic outputs from the course: past students report changes in their parctice including the formation of staff support groups and collectiv eworking replacing indisvidual and isolated approaches. Like last year current students are very enthusiastic about the course and its promotion and I am utilizing their zeal by challenging them to encourage a colleague each onto the next course.
The Pilot
The pilot was invaluable and most encouraging in that it demonstrated that the format and content were attractive to the broad range of agencies that we had targeted. Predictably, filling the course and following up our advertising needed considerable effort and many applicants came quite late in our plans. Nevertheless, in the final analysis we were oversubscribed and able to start a list for the following year. Regrettably, teaching colleagues who started with the course have moved on and filling their places is proving difficult – there is a culture of work overload prevailing in the NHS and good candidates are already under considerable pressures on their time. A significant development during the course was the attachment participants made to each other and the course process. Clearly the conversational aspect of the teaching modality, the small groups and particularly the Experiental group have provided new and, for some, profound experiences.
I had been approached by two members of the Community who were about to complete their time with us to give them a place on the Course. I had anticipated involving service users as ExE but felt some trepidation at the implications of their full participation alongside other professionals. In the event this has proved a most valuable initiative for all and I have repeated this inclusion in the second year. The advantages of their presence on the course are several but most significantly it lends a particular sensitivity to and respect for the plight of those with this diagnosis.
The course has been a great success and many of this second year’s cohort came forward on the recommendation from participants in the pilot year.
I am confident that we can fulfil the intention to seed increased awareness, sensitivity to and knowledge about Personality Disorder.
Ten participants including the two ex-members of the Community have submitted written assignments for University credits.
COURSE APPRAISAL FORMAT
We have invited you into random groups to evaluate the Course. Later, towards the end of this last term, we will invite your more personal responses. Today we would like you to work together in a group to arrive at your responses. To allow for an effective outcome we would like you to choose a Chairperson who will keep the group on task and manage its time. The groups will have 30 minutes to allow for election, dialogue and discussion and to formulate conclusions. You will need to nominate someone to act as scribe to record your findings and to feed back to the larger group. We have allowed 10 minutes for each group to do this.
It might help if you separate of the course into three elements:
Information input – the seminars, presentations, lectures, reading etc.
Processing – discussion, dialogue, work groups, your personal logs. (remember?) etc.
Our intentions were that:
The course will facilitate a better understanding of the relational difficulties inherent in working with this client group as well as enable participants to explore their own experiences with colleagues from across the Care spectrum. Additionally, we will work towards developing a common theoretical base to understand the aetiology, nature and clinical features of Personality Disorder. The course is interactive and provides opportunities for participants to experience group work and to gain the self-awareness skills essential to understanding and working with this client group.
And specifically:
To sharpen students’ skills in the recognition and assessment of severe Personality Disorders.
To facilitate an integrated inter-professional, inter-agency approach to the care and treatment of clients diagnosed with SPD.
To encourage the setting of realistic treatment goals based upon an increased knowledge of the aetiology and symptomatology of SPD.
To foster awareness of the impact of this client group on front line professionals and their need for ongoing supervision and support.
To enable students to develop reflective practice within the multi-disciplinary context through understanding others’ roles and the exploration and resolution of conflict in the clinical setting.
The groups worked enthusiastically at the task partly because it empowered them and offered an opportunity to sublimate some negative feelings always present i.e. envy etc. Nevertheless criticism was mostly constructive and the course seems to be highly valued. An issue for me, keen to promote the idea that expertise resided in the professional group and that I wanted to foster a mature inter-professional exchange, was how dependent the group remained. There were traces of this unsatisfied need in the feedback session with requests for more “feeding” more handouts, more time, more directions, more answers!
Feedback
“Thought provoking – not always accessible-more explanation needed sometimes-copies of my notes-more handouts-handouts very useful-content pitched very well-
Generally, students noted that this was a pilot and they would want reading lists and course structure up front.”
“Well planned-well organised-information covered several levels-different people wanted more of different things – more on group process, longer seminars-more time for questions-more structure-very much appreciated ExE inputs very valued-reading good- more handouts –less jargon-Attachment ideas most useful-reporting increased tolerance and understanding of clients-deeper understanding of the concept and its impact on clients lives and the workers-increases self awareness and understanding of our own frailties
Generally reported deepening understanding & awareness and knowledge and empathy for SPD clients
Changes back at the workplace - challenging colleagues and introducing the topic- changes in practice – work group case studies very helpful – Idea of keeping personal log very useful – time should be given by employers to do the reading – sometimes people have left the course feeling depressed/ disillusioned and disheartened with a sense of futility – not feeling very confident about “champion” role – How can we get supervision and support – from each other?
Experiential group should be shorter/longer, profound experience/ waste of time, challenging – changed attitudes, challenges others, more self-aware, more confident and able to stand my ground – more aware of clients difficulties in groups – splitting and other defences we have talked about – uncomfortable thoughts and feelings – improved self-confidence
Discussion opportunities are interesting and useful – Would like to look at successful treatments - want to know how to get it right – Most found experiential group one of the most useful – Would like more discussion of seminar material
FOOD FOR THOUGHT!
Plans
Following completion of the pilot, I have spent a great deal of time working through improvements both on the basis of users’ feedback and my own and colleagues’ observations. I am developing an interactive teaching/learning aid in the form of an accompanying folder which will link sessions and thinking and allow students to reflect on, anticipate and prepare for areas of particular interest between sessions. I am convinced that this will greatly improve active participation in the course. As well, I am producing Power Point visuals for each session which engage participants from the start and focus on content and developments week to week. Students like this format and have requested synopses of my presentations which I now provide.
Financially, without the prospect of further NIMHE monies, I feel secure enough to plan continuing the course for the foreseeable future at an attractive fee – some three more years until my retirement. In the meantime I need to identify and involve others in the totality of the course production. There has been interest from course participants and from service users in going on to develop in-house awareness days and I am keen to encourage and to promote these both with my time and some financing as necessary.
Finances
Monies received from NIMHE are kept in a Cost Centre B1204 within the finance department of West Kent NHS and Social Care Trust and a monthly report of expenditure for the period is produced. As well as the total income from NIMHE of £30,000, in this second year I have charged £300 per participant. With 24 participants this year we attracted further income of £7200. At end August 2005 we had £21,277 in the account. (See attached Report for August, 2005).
A full account of all spending is available from Finance department upon request.
The major expenditure has been my salary for an additional day a week so that I can plan, develop, publicise, and deliver the course and it’s offshoots. This was some £7,500 in the first part year and will be some £11,000 in the next full year and in future years. Other one-off expenditure has been on equipping the course which has included a projector, screen and laptop. I have kept publicity and advertising expenditure to a minimum by producing it all myself. I upgraded my printer for the task. I pay the Service secretary for her time on administration tasks for the course which includes contacts, dealing with applications, photocopying etc. I have bought some books and other teaching resources and materials. We have the advantage of staging the course at the Brenchley unit thereby avoiding venue costs. As mentioned above in order for the course to become self funding and so survive, I am charging £500 for the coming year 2006-2007.
Roger Davies
March 2006
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