Therapeutic relationship is key to recovery from personality disorder

(Medical Xpress)—Patients in Rampton Hospital, a secure psychiatric unit in Nottinghamshire, have reported that the single most important factor affecting their recovery was the support and commitment of their therapist.

A new study by researchers Phil Willmot and Professor Mary McMurran at the Institute of Mental Health, a joint venture between The University of Nottingham and Nottinghamshire Healthcare, explored the changes during treatment of male inpatients diagnosed with severe personality disorders.

The research is published in the journal Legal and Criminal Psychology and will be a valuable contribution to wider ongoing enhancements to the treatment of long-term detained psychiatric patients with a personality disorder. The study is unique in that it was carried out in the form of detailed interviews and questionnaires filled in by the patients themselves. It shows how the behaviour of therapists is vitally important throughout treatment and by the final stage of therapy patients begin to value interactions with other staff as also important.

Forging attachments

Fifty patients, all with a diagnosis of personality disorder and convicted of serious violent or sexual offences, were asked about what they thought were the most important factors that had helped them to change in hospital.

Patients in the early stages of treatment rated the influence of their therapist as the most important factor. For patients in the later stages of treatment, relationships with nursing staff and the content of therapy became more important, but the relationship with the therapist remained important throughout the treatment process.

Phil Willmot, PhD student and consultant psychologist in the Men's Personality Disorder Service at Rampton Hospital, said: "Many therapies for personality disorder are designed to provide what children need if they are to grow up emotionally healthy; things like feeling safe, understood and cared for. Many of our patients have suffered severe abuse or neglect in childhood and so missed out on these experiences. These results are important because our patients are confirming the vital nature of these experiences to the process of recovery from severe mental health problems."

Crucial role of therapist

Dr John Wallace, Clinical Director at Rampton Hospital, added: "This important study adds to the evidence base concerning the crucial role of the therapist-patient relationship in the therapeutic process. While this is apparent to therapists working with patients with personality disorder, the evidence in this report is provided by patients with the severest forms of personality disorder and with extremely complex needs."

This research provides valuable evidence about the process by which people with personality disorder can be helped in their recovery. Future work in this area aims to further explore the process of change and improve the effectiveness of treatments for severe personality disorders.

The study 'An attachment-based model of therapeutic change processes in the treatment of personality disorder among male forensic inpatients' by Phil Willmot and Mary McMurran is published on Monday 19 May 2014 in The British Psychological Society's journal Legal and Criminal Psychology.