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      Exploring dialectical behaviour therapy clinicians’ experiences of team consultation meetings

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          Abstract

          Background

          This article presents a detailed idiographic analysis of Dialectical Behaviour Therapy (DBT) clinicians’ experiences of team consultation meetings. DBT is an evidence-based psychological intervention with a demonstrated efficacy in the treatment of borderline personality disorder (BPD). Team consultation meetings encompass one of the primary components involved in this treatment model; where DBT clinicians regularly meet to discuss client work and enhance further learning. The present study’s aim was to assess what are DBT clinicians’ experiences of the consultation meeting component and whether it is useful or not.

          Method

          Semi-structured interviews were completed with 11 DBT clinicians (nine females, two males) from three different consultation teams. The research project utilised an interpretative phenomenological analysis (IPA) framework. Audio-recorded interview data was analysed using this framework.

          Results

          Four superordinate themes emerged from the interview data, which included ten subordinate themes. The superordinate themes focused on: (1) the acquisition of DBT technical knowledge and other MDT related expertise (2) participants’ emotional experiences of DBT and consultation meetings, and how this can evolve over time (3) the underlying processes that occur in the consultation team including the development of a team bond and the impact of membership changes and (4) the largely consistent and reliable nature of consultation meetings and how they help maintain clinician motivation.

          Conclusions

          Team consultation meetings were found to be supportive; playing an important role in maintaining clinician motivation through the availability of team support, opportunities to reflect and learn, and assistance in regulating emotions. Challenges arose in relation to team membership changes and acclimatisation to the type of feedback utilised in team consultation. The study’s implications for practise are considered.

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          Most cited references21

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          Mechanisms of change in dialectical behavior therapy: theoretical and empirical observations.

          Dialectical behavior therapy (DBT) can be considered a well-established treatment for borderline personality disorder (BPD) as evidenced by seven well-controlled randomized clinical trials across four independent research teams. The primary purpose of this article is to address a variety of potential mechanisms of change that may be associated with those aspects of DBT that are unique to the treatment and its theoretical underpinnings. Based on the biosocial theory of BPD, many of these mechanisms can be distilled down to the following process: the reduction of ineffective action tendencies linked with dysregulated emotions. Specifically we address the following interventions and associated mechanisms of change: mindfulness, validation, targeting and chain analysis, and dialectics. Patient change in BPD is conceptualized primarily as helping the patient to engage in functional, life-enhancing behavior, even when intense emotions are present. Ultimately, our goal was to provide guidance for theoretically and empirically grounded research on the mechanisms of change in DBT. Copyright 2006 Wiley Periodicals, Inc.
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            Demonstrating validity in qualitative psychology

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              Staff attitudes toward patients with borderline personality disorder.

              Our aims were (1) to develop 2 inventories for the measurement of cognitive and emotional attitudes toward borderline personality disorder (BPD) patients and their treatment and (2) to use these tools to understand and compare attitudes of psychiatrists, psychologists, and nurses toward BPD patients. Two lists of items referring to cognitive (47 items) and emotional attitudes (20 items) toward BPD patients were formulated. Fifty-seven clinicians (25 nurses, 13 psychologists, and 19 psychiatrists), who had been working in public psychiatric institutions for more than 1 year, rated their level of agreement with each item. The list of cognitive attitudes yielded 3 factors (required treatment, suicidal tendencies, and antagonistic judgment). The list of emotional attitudes yielded 3 other factors (negative emotions, experienced difficulties in treatment, and empathy). Psychologists scored lower than psychiatrists and nurses on antagonistic judgments, whereas nurses scored lower than psychiatrists and psychologists on empathy. Regression stepwise analyses conducted on the 3 emotional attitudes separately showed that suicidal tendencies of BPD patients mainly explained the negative emotions and the difficulties in treating these patients. All groups were interested in learning more about the treatment of these patients. Suicidal tendencies of BPD patients provoke antagonistic judgments among the 3 professions. Nevertheless, psychiatrists, psychologists, and nurses hold distinctive cognitive and emotional attitudes toward these patients. Mapping these differences can improve the education and training in the management of BPD patients. Copyright © 2011 Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                cian.walsh@hse.ie
                patrick.ryan@ul.ie
                danielm.flynn@hse.ie
                Journal
                Borderline Personal Disord Emot Dysregul
                Borderline Personal Disord Emot Dysregul
                Borderline Personality Disorder and Emotion Dysregulation
                BioMed Central (London )
                2051-6673
                27 February 2018
                27 February 2018
                2018
                : 5
                : 3
                Affiliations
                [1 ]GRID grid.424617.2, Cork Mental Health Services, Health Service Executive, Psychology Department, Inniscarrig House, ; Western Road, Cork, Ireland
                [2 ]ISNI 0000 0004 1936 9692, GRID grid.10049.3c, Department of Psychology, , University of Limerick, ; Limerick, Ireland
                [3 ]GRID grid.440338.8, Cork Mental Health Services, Health Service Executive, , Block 2, St Finbarr’s Hospital, ; Cork, Ireland
                Author information
                http://orcid.org/0000-0002-6204-3669
                Article
                80
                10.1186/s40479-018-0080-1
                5838873
                80c74898-91f1-44fe-bae7-37c03f58ecec
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 13 November 2017
                : 14 February 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                dialectical behaviour therapy,implementation,team consultation,borderline personality disorder

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