Personality Disorder Treatment – A Different Approach
Field House is a specialist rehabilitation service for women with a history of trauma and/or attachment disorders. The service focuses on psychological input and provides specialist, evidence-based interventions including Trauma focussed Cognitive Behavioural Therapy (TFCBT) and Compassion Focused Therapy (CFT) (Gilbert 2002).
The majority of patients at Field House have a diagnosed Personality Disorder, however, the model is very different to services that provide Dialectical Behavioural Therapy (DBT) as their primary intervention.
Phil Coombes, Clinical Director, says,
“Although I am DBT trained and we do offer DBT modules at Field House, we do not run the full DBT programme. Over the last ten years of working with women, my observations and evaluations have highlighted that DBT sometimes expects too much emotional awareness and understanding from this patient group. The model at Field House provides an alternative for women who cannot engage fully with the intensive DBT programme or for those who have tried DBT and have not achieved successful outcomes.”
What is the model at Field House?
Field House offers a unique model that combines Positive Behavioural Support (PBS) with Compassion Focussed Therapy (CFT). PBS enables service users to understand the function of their behaviours and enables patients to develop the ability to share that with others in their lives thus reducing maladaptive coping mechanisms and the likelihood of incidents.
CFT has a focus on nurturance and compassion and supports service users to become less critical and judgemental of themselves and others.
The combination of the two models helps break down the threat system that often prevents people moving on from services and aims to develop a true understanding of the function of a person’s behaviour in order to develop effective support strategies
How does it work?
Not all patients with a Personality Disorder and/or attachment disorder are ready to engage with an intensive therapeutic programme. Intensive programmes require commitment and motivation which is often lacking and therefore prevents patients from progressing through their care pathway. DBT equips patients with skills to label and manage emotions however it assumes a certain level of cognitive ability.
The model at Field House incorporates Herman’s phase-based approach to working with trauma and attachment difficulties.
Phil Coombes suggests that many patients who have experienced trauma are ‘stuck’ emotionally at the age when they experienced the initial trauma so a less critical framework of safety, stabilisation and compassion works well with this patient group.
How is it different to the DBT approach?
Recent research regarding CFT has highlighted significant gains for patients with a Personality Disorder and using a CFT framework can help move forward the most ‘stuck’ and difficult to place patients.
The interventions at Field House helps patients to understand the biological components to behaviours, as well as physiological and psychological responses. The biological element of the intervention helps to destigmatise a patient’s view of themselves and others and helps them to understand that we are all programmed with a survival instinct that can override our cognitive thoughts. Ultimately, this supports patients to become less judgemental and/or ashamed and reframe their thoughts.
What does this mean for patients?
Patients will be able to access appropriate treatment at a level that is tailored to them as an individual.
The team at Field House recognise that one approach is not suitable for all patients with similar diagnoses. Using an alternative treatment approach to DBT allows the team to offer placements and work with patients who are assessed as unsuitable for DBT programmes or who have tried other therapeutic programmes with little success.