Examining service users’ views on their experiences of recovery from borderline personality disorder across settings: A systematic review, and borderline personality disorder; secure inpatient service users’ perspectives on what recovery means, its facilitators and barriers

Baily, James 2023. Examining service users’ views on their experiences of recovery from borderline personality disorder across settings: A systematic review, and borderline personality disorder; secure inpatient service users’ perspectives on what recovery means, its facilitators and barriers. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

The current thesis explores the experiences and views of recovery of individuals with a diagnosis of Borderline Personality Disorder (BPD), alongside any facilitators and barriers they have identified. BPD is characterised by extreme emotions, significant difficulties with relationships and a need to connect to others but struggling to trust them. The systematic review focused on a range of service settings, and the empirical study focuses on forensic settings. Qualitative research approaches provide an opportunity to investigate lived recovery experiences and understandings of people with BPD. This systematic review aimed to use thematic synthesis to integrate findings from selected studies relating to recovery from BPD in a range of service settings, predominantly community. A systematic review protocol was developed and searches were run on five databases to identify qualitative peer-reviewed studies relating to the experiences and views of service users with BPD. PRISMA guidance was followed and nine articles were selected for inclusion. The quality of each article was evaluated using the CASP qualitative quality measure. Thematic synthesis was completed to develop themes. Two superordinate themes emerged: ‘Change, not ‘recovery’’, with two subthemes; and ‘Change is complicated’ with five subthemes. These reflect participants view that change is non-linear, and a combination of a variety key elements supporting change are needed for SUs to improve their wellbeing. A model is proposed to illustrate SUs views of recovery and wellbeing. Chaotic environments and traumatic experiences lead to disrupted early development, contributing to the intense relational and emotional challenges experienced by people with BPD. For individuals with BPD, this can make engaging with services overwhelming and challenging in the long-term. The SU meaning of recovery is broader than symptom reduction alone and it is important to incorporate this into current understandings of recovery with BPD. Staff would benefit from appropriate training to work with people with BPD. Possible areas for further research are discussed. This thematic synthesis contributes to the literature by highlighting that participants understandings of recovery are broader than symptom reduction alone, incorporating wider life factors and the knowledge that life will always present challenges, despite learning to cope better and maintaining wellbeing for longer. Participants point out recovery is non-linear and better described as living well despite their mental health challenges. Staff knowledge and training, a non-judgemental environment, trusting relationships, SU’s learning new skills and having ongoing meaningful activities are key in the process of positive change. The second part of this thesis, the empirical study, focused on SUs experiences and conceptions of BPD recovery and the facilitators and barriers to it in forensic settings. The SU voice is under-represented in the research literature. Male service user views are also under-represented, and this study aimed to ensure this population was included. An Interpretive Phenomenological Analysis (IPA) approach was used to explore the experiences of seven participants; three female and four male. Participants were inpatients receiving treatment in medium secure mental health services. Interviews focussed primarily on experiences and understandings of recovery and its facilitators and barriers. Themes were developed for each interview transcript, followed by a process of drawing out group experiential themes. Analysis resulted in four group experiential themes. The first, ‘Developing BPD, instability early in life’ relates how negative early life experiences impacted participants’ mental health and development. The second, ‘Developing awareness and taking the first steps to recovery’ is concerned with beginning the recovery process and what participants need. The third, ‘Anticipating and living the reality of recovery’ outlines participants understanding of recovery. The fourth, ‘Overwhelmed by the power of a problematic system’ identifies participants challenging experiences whilst in medium secure treatment settings. This study contributes a SU perspective on recovery in forensic health settings, which has wide overlaps with previous research on recovery in a range of health settings. Participants understandings of recovery are that it is a non-linear process with periods of wellbeing and mental health challenges, or ‘yellow brick road’ as one participant described it. Living well with BPD using new strategies and good relational connection, supported by knowledgeable and compassionate care environments, seemed more realistic to SUs. However, in the forensic setting, epistemic injustice and iatrogenic harm are more strongly emphasised as barriers to recovery. Psychologists with experience in this field could offer training to staff, family and significant others.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	17 October 2023
Last Modified:	12 Oct 2024 01:30
URI:	https://orca.cardiff.ac.uk/id/eprint/163149

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