Staff Support Worker perceptions of adolescent patients diagnosed with Borderline Personality Disorder: an Interpretative Phenomenological Analysis

Coombes, Jessica Holly (2019) Staff Support Worker perceptions of adolescent patients diagnosed with Borderline Personality Disorder: an Interpretative Phenomenological Analysis. Doctoral thesis, London Metropolitan University.


Borderline Personality Disorder (BPD) patients are considered among the most challenging groups to work with, being associated with impulsive risk-taking behaviours and difficulties engaging in the therapeutic alliance (Bender, 2005; Black, Blum, Pfohl, & Hale, 2004; Cruz & Soriano, 2014). It is apparent that many mental health professionals hold negative attitudes towards this group and report feeling underequipped to work with the challenges associated with BPD ((Bland, 2003; Cleary et al., 2002; Shanks, Pfohl, Blum & Black, 2011). It is suggested that support workers, who require little to no formal training and are considered front line staff, provide a significant portion of care to this patient group (Kenward et al., 2001). However, there is little to no research focusing on understanding their role with young BPD patients and the impact they have on therapeutic outcomes.

The following research aimed to explore the perceptions of support workers working with young BPD patients in inpatient services. It aimed to open up the discussion on what it is like to be a support worker in this environment and the challenges they may face, also hoping to enhance our understanding of any training and support needs required for effective therapeutic outcomes. This research may provide some insight into how support workers perceive their role, their attitudes towards young BPD patients, and how best to support them to achieve positive therapeutic alliances.

Semi-structured interviews were conducted with six participants. The transcripts were then analysed using Interpretative Phenomenological Analysis.

Four superordinate themes emerged: Attachment, Boundaries and Ruptures; the Emotional Rollercoaster of Managing Selfharm; Co-existence of Hope and Hopelessness and Making a Difference. Eight subordinate themes, related to the initial superordinate themes, are discussed in further detail. The research highlights the challenges support workers face and the difficulty they have developing the therapeutic alliance with young BPD patients and the subsequent impact this could have on therapeutic outcomes. It suggests that the training and support needs of support workers are under emphasised and could be having an effect on the therapeutic outcomes for this patient population. This research makes implications for clinical practice bringing forwards the needs of support workers who have a front line role. Being an under-researched area, the potential for future research
is plentiful.

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