Integrative Psychotherapeutic Group Work - a way forward in the treatment of personality disorders

2. Integrative Psychotherapeutic Group Work - a way forward in the treatment of personality disorders Gill Attwood & Lisle Scott

3. Thames Valley Initiative

5. Facts and Figures • Population of 770,000 • 62-68% aged between 18-64 • 5-10% 0f population have a Personality Disorder 25% of GP attendees have PD • 50-70% of mental health patients have PD (Moran) • Estimated population of Oxfordshire with PD is 38,500-77,000 (Moran)

6. OCNS Staff • Multi-disciplinary team • Psychiatrists, Psychotherapists, Nurses, Social Workers, OTs, XbX’s, Administrators • 12 whole-time equivalent • Working with-in a framework of multi-modality • Hold CPA responsibility for members in therapy and post therapy for six months.

8. Tier 1 • Open referral system • Everyone seen – mostly with-in own geographic area, in various settings, GP surgeries, CMHT bases, Voluntary day centres etc • Initial engagement, not full assessments • Assertive engagement – includes individual time limited psychotherapy

9. Tier 1- Options Group • 4 across the county • Staffed by clinicians, XbX’s and attended by members of the therapy group for each area • Attendance 4 wks-12months • 2 hours a week • TC structure • Identify issues to work on

10. Tier 2 – Spoke services • 3 across the county • Plus one for older people • Staffed by Clinicians • Using an integrative psychotherapeutic approach

11. Tier 3 – Full-time TC • 4 ½ days a week • 18 month commitment • Democratically run by members • Multi-psychotherapy approach, Analytical groups, CBT, Psychodrama, Creative group, Medication group, SCID II group

12. Tier 4 Moving-on • 8 sessions across 16 weeks • Start 2 months before completing therapy • Finish 2 months after ending therapy • Social re-integration programme • Focus on work, education, and preventative strategies • Remain in the care of OCNS for 6 months after completing therapy • STARs programme after 6 months – employed in training and research areas, including a mutual support network

13. Other OCNS Endeavours • Comprehensive student placement package- taking up to 5 students at any one time • Friends and Family group – 12 week education programme plus on-going support group • Consultation group – weekly in various locations for professionals working with those who have PD • Ethnic minorities group about to be set up • Exploring the possibility of a spoke service in the local prison • Supervision of Mind group programme • Training and education strategy – to include support to out-side agencies, and support to staff to develop skills • Commitment to research and audit

15. What does integration mean? • Psychodynamic Psychotherapy + • Sociometric Theory and Practice + • Psychodrama/Action Methods + • Cognitive Behavioural Therapy + • Cognitive Analytic Therapy + • Biological Psychiatry

16. How do we Integrate these? • 1 weekly Analytic Group + • 1 weekly Integrative Therapy Group contained within Community Meetings using democratic TC principles + • Fortnightly administrative individual sessions: SCID, Outcome measure tools, CPA.

17. How do we Integrate these? • Coupled with the integrative model is a responsiveness to the needs of the group, providing themes for exploration within the group • Depending on the theme, the leading psychotherapeutic approach is chosen, enabling the mapping of difficulties usually on paper, using CAT, CBT or Sociometric tools. • The theme is then explored further using psychodramatic techniques, in conjunction with psychodynamic interpretation

18. Containment • 24 hour peer telephone support • Consistent boundaries • Self regulation within a democratic framework • Clear entry and exit processes • Mechanisms for psychiatric emergencies

19. Continuity • Start in pre-therapy group for up to 12 months – with a staff link • Care transferred to OCNS at 3 months • Constant core staff team • Graduated social re-integration program • Six month follow-up

20. The Group03/05 – 03/07

21. Evaluation - MDS Service area Annual prior Annual since Reduction to joining the group joining the group

22. Evaluation - CORE W P F R

23. Cost Savings – 7 completers

24. Cost Off-set Annual capacity - 30 Total annual savings - £287 622 Service cost - £32 538 Total annual savings - £255 084

25. Conclusion Perhaps the results speak for themselves, BUT it is NOT simply about economic benefit! These individuals have experienced a dramatic improvement in quality of life.

26. Feedback • “I am now able to live independently – I no longer need my son to be my carer” • “I never thought I could survive without benzo’s” • “The group gave me the confidence to facilitate a session and return to college” • “I never believed I could be angry and be okay”

27. Tying the Strands Together • Carey – healthcare professional • Presented in numerous vignettes – cited as one of most challenging to other health professionals • Skilfully avoids personal work by working hard on interpretations for others

28. Situation Feelings NAT’s Evidence