Training and Education
Maria Duggan spoke of the crucial aspect of up-skilling the workforce and presented the finding of the English capabilities framework document which was an assessment of training needs in England and alerted us to the publication of the evaluation of all the various trainings which were funded by DoH across England.
DBT, Mentalisation based treatment and CBT have all been presented at SPDN conferences as theoretical models for delivering care to this group (see later for description). These approaches all have considerable implications for workforce training requirements A number of health board areas have presented trainings that they are offering from psychotherapy and psychology departments to other staff.
Future developments
A collection of the different trainings being offered locally will be on the website allowing other areas to replicate their model or for local people to find out what's available.
The Mental Health Delivery plan is emphasising importance of psychological therapies being available to more patients and the consequent need to train the workforce to meet this. It is anticipated that the needs of those working with PD will be included in this.
Mentalisation based treatment (MBT) was presented by Professor Anthony Bateman. Professor Bateman is a highly acclaimed psychotherapist and researcher who has devised evidence based manualised treatment using attachment theory as the underpinning knowledge base. The great advantage of this approach compared to traditional psychodynamic psychotherapy approaches is that it has manageable training requirements. There is a body of clinicians interested in pursuing this training in Scotland and evaluating it across Scotland.
Dialectical Behaviour Therapy (DBT) has been presented from a number of perspectives. This manualised therapy which has its basis in CBT, mindfulness and Buddhism was first described by Dr Linehan in USA as an effective intervention for women who self harmed. It has since diversified and is being used to treat people with a diagnosis of borderline personality disorder. Professor Reid pointed out that the evidence base was not as robust as for CBT or Psychodynamic psychotherapy. Dr Michael Gotz, Consultant Psychiatrist has been trained along with his clinical team in DBT and presented their experience. The patients appreciated the time invested in the therapeutic approach which is considerable but he wasn't sure that this was a reflection of the specific intervention. He found the model very "American" and difficult to translate to his patient population, the training was demanding and the time investment in therapy per patient considerable. The final results of the project are yet to be gathered and we would hope to hear from him again at that point.
Cognitive Behaviour Therapy (CBT) has been researched by Professor Kate Davidson in Scotland as part of a British multi centre trial with considerable numbers of patients participating and positive outcome. One of the points Professor Davidson stresses is the need for therapists to be trained and supervised to keep to the therapeutic model.
Future developments
A more thorough assessment of training needs for working with PD can be gained from the work in England as described above. It is hoped we might utilise this through NES and not need to repeat the exercise in Scotland.
The Mental Health Delivery Plan, which was launched in December 2006, makes a commitment to increasing the availability of psychological therapies available to a broader group of service users. This group will include those with personality disorder and will help to alleviate the perceived exclusivity of psychoses as the only "severe and enduring" mental illness.
The need for training in working with PD is well documented. This does not just refer to specialist interventions but to generic health workers who need to have a model in which to understand the complex and sometimes provocative nature of interactions that can occur.
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