Specific psychosocial interventions

The principal factors are listed in the Borderline Personality Disorder NICE Guideline and include:

• having an explicit and integrated theoretical approach used by treatment team and therapist and shared with the patient
• provision for appropriate therapist supervision
• clear structuring of care
• being relatively longer term (NICE guidelines suggest interventions of less than 3 months should be not used to treat personality disorder unless the short intervention forms part of a longer term treatment plan.

This is in part because emotional dysregulation associated with perceived abandonment is likely when a treatment ends and a shorter treatment is unlikely to provide the opportunity to learn the skills needed to self-regulate effectively).

All specific psychosocial interventions should be delivered by professionals with the appropriate training, experience and competencies. Given the challenges of working with people with personality disorder, appropriate supervision is crucial. The intensity, frequency and form of the supervision required is likely to vary from intervention to intervention. For example, the clinicians delivering an extensively manualised treatment such as STEPPS may benefit from brief postgroup peer supervision between skills trainers, multidisciplinary discussion at CMHT meetings, and discussion within usual clinical supervision. However, at times, certain challenging issues may arise which may warrant additional supervision. Some more intensive interventions like Dialectical Behaviour Therapy (DBT) have scheduled weekly supervision built into the treatment model.

While psychosocial interventions should as far as possible be delivered according to the protocols upon which evidence of benefit is based, it is recognised that rurality and remoteness may sometimes make this impossible. In these situations, a flexible, pragmatic approach is advised. For example, it may be reasonable to consider delivering the STEPPS materials to a patient on an individual basis if attendance at a group is impossible. However, in such a case, it should be made clear that the intervention which is being delivered is not STEPPS per se, and consideration needs to be given to the treatment frame and related factors. The Personality Disorder Service is available for consultation as required. While it is acknowledged that some interventions may address more than one phase of treatment, for the sake of clarity, the interventions commonly available in NHS Highland are listed below under the phase of treatment which represents the usual primary focus.

The description for each intervention attempts to answer four questions:

Each Intervention is on a separate page to simplify printing.