Experiencing health services and mentalisation-based treatment for borderline personality disorder:service user perspectives

This doctoral thesis begins with a literature review that explores how individuals who meet criteria for borderline personality disorder (BPD) experience health services. Following a comprehensive literature search, a metasynthesis of 14 papers was conducted utilising Noblit and Hare’s (1988) meta-ethnographic approach. Findings indicate that the attitudes of professionals are exceptionally important to service users but are often experienced by them as judgmental and dismissing. Service users highly value communication, consistency and input into their own treatment and sometimes search for containment and meaning within health services. Barriers to treatment are highlighted which include negative attitudes from professionals, lack of input into treatment and insufficient security and support for service users in the community. Implications for health services are explored. The research paper that follows this is an interpretative phenomenological analysis (IPA) study on the experience of mentalisation-based treatment (MBT) for BPD from the perspective of adult service users. Seven participants were interviewed and findings illustrate that the group component of MBT was experienced as challenging and unpredictable. Trust was identified as key to benefitting from MBT and was much more difficult to obtain in group sessions than in individual therapy. However, participants attending MBT for longer than three months appeared to make progress with this. The structure of MBT generally worked well for participants but individual therapy was identified as the most important component and specific challenges were highlighted. All participants learned to look on the world differently due to MBT which resulted in a positive shift in experience for them. Implications for MBT are discussed in this paper. The subsequent section in this thesis is a critical appraisal that highlights key learning points and reflections from conducting the research paper