Psychosocial interventions
Personality disorder integrated care pathway
Introduction
A psychosocial intervention can be defined as any intervention that emphasizes psychological or social factors rather than biological factors. Psychosocial interventions can be taken to include specific psychological therapies, such as Dialectical Behaviour Therapy (DBT), and more general interventions, such as crisis planning, problem-solving training and psychoeducation.
All psychosocial interventions for personality disorder should be concordant with, and informed by, the concepts described in the General Principles Section of this document, namely:
• Recovery
• General treatment strategies of:
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- Collaboration
- Consistency
- Motivation
- Validation
- Self-knowledge and self-reflection
- Stages of change model
• Phase-based treatment:
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- Phase 1: Stabilisation (Making Stable): this phase, with a primary focus on the present, deals with safety, containment and promotion of self-regulation and control.
- Phase 2: Exploration and Change (Making Sense): this phase, with a primary focus on the past, can commence once stabilisation occurs, even temporarily. The aim is to identify and make changes to the factors which underlie the unhelpful behaviours. This phase can involve dealing with the effects of trauma and dissociation; treating self and interpersonal problems; and treating maladaptive traits.
- Phase 3: Integration and Synthesis (Making Connections): this phase, with a primary focus on the future, is not so much about changing existing psychological and interpersonal structures and processes as putting new ones in place. The aim is to promote a more integrated sense of self and a healthier interpersonal environment — this may include new leisure activities, occupational/educational activities, new roles and relationships.
• Matched care
The psychotherapies for personality disorder which have evidence of effectiveness are largely derivatives of either psychodynamic approaches, or cognitive-behavioural approaches, although some have features of both. Within NHS Highland, the specific psychosocial interventions available are primarily cognitive-behavioural in orientation. For example, STEPPS and DBT, the two main Phase 1 treatments for borderline personality disorder available in NHS Highland, are cognitive-behavioural treatments.