title: Experiences of dialectical behavioural therapy by adults diagnosed with borderline personality disorder
Creators: name: Smith, Donald
Publisher: name: University of Liverpool Repository
Year: 2014

description: This dissertation for the Doctorate of Clinical Psychology at the University of Liverpool focuses on the experiences of receiving dialectical behaviour therapy (DBT) in the community by adults diagnosed with borderline personality disorder (BPD). It comprises three distinct chapters, namely a literature review, an article detailing an empirical study, and an extended discussion. Chapter one presents the findings from a literature review that systematically searched the qualitative literature for studies that explored the experiences of receiving community-based DBT by adults diagnosed with BPD. The chapter begins by briefly describing the history, diagnostic criteria, prevalence, and symptoms of BPD, before describing the components of DBT, a psychological treatment that has received strong empirical support for the treatment of BPD. Findings from the systematic search of the qualitative literature reveal five articles that fit the review’s inclusion criteria; this paucity of qualitative research investigating clients’ accounts of DBT in actual clinical settings is surprising considering that DBT has received growing support for its efficacy since the publication of its treatment manual in 1993. When considering the findings from the five qualitative articles, the picture of clients’ experiences of DBT is unclear, as the studies vary fundamentally in their research design. For example, the qualitative studies differ in their research design, including the use of structured interviews, semi-structured interviews, and focus groups, and vary in the methodological approaches deployed to analyse the data. Also, the DBT programmes from which participants were recruited in the qualitative studies differ in their fidelity to the DBT model. With the systematic search of the qualitative literature revealing so few studies exploring the experience of receiving community-based DBT by adults diagnosed with BPD, together with their methodological and analytical differences contributing to an unclear account of the experience, chapter two of this dissertation presents an empirical study aiming to augment the qualitative literature that explores the experience of receiving community-based DBT by adults diagnosed with BPD. This empirical study is vital as not only does it consolidate the existing qualitative research, but, remarkably, is believed to be only the second study of its kind to be conducted in the National Health Service (NHS), with the first being conducted over 6 years ago. The aims of the empirical research are to capture participants’ expectations and experiences of the DBT programme, the impact and experience of the multi-modal components of the programme, determine the meaning of a ‘life worth living’ to someone diagnosed with BPD, and gauge whether DBT contributes to a ‘life worth living’, which is DBT’s overarching aim. Six participants are interviewed, all of whom are diagnosed with BPD and have experience of a community-based DBT programme delivered by the NHS. Six themes are found from analysing the qualitative data derived from the interview transcripts. As the intention is to publish both the literature review and empirical paper in academic journals, and academic journals invariably set a limit regarding the maximum number of words or pages for research articles, the third chapter of this dissertation elaborates on the points made in the discussion section of the empirical article in chapter two. The elaborations extend the implications of the findings to the wider research. Links are made to the wider research literature that focuses on group therapies, and the literature suggesting that those diagnosed with BPD struggle to foster therapeutic alliances with therapists. Links are also made to clinical practice, especially in light of fundamental changes to the landscape of the NHS, such as the Coalition Government’s target to make £20 billion of efficiency savings within the NHS by 2014, and the NHS now facing competition from ‘Any Willing Provider’ offering healthcare provisions. Overall, the participants’ experiences of DBT found by the empirical study presented here is encouraging, and it is hoped that such positive views from users of the NHS may go some way to balance the criticism the NHS has received over the years regarding the quality of care it provides to the public. Chapter three also includes a different version of the empirical article, written for employees and clients of the Trust in which the research was conducted. Chapter three concludes with a section detailing how the empirical research presented in this study could be usefully extended.