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Working with Complexity: Essential Competencies for Working with People with Personality Disorder

Module description

The module focuses on the essential knowledge and clinical competencies (skills) required to undertake Cognitive Behavioural Therapy (CBT) with people with personality disorder (CBT PD) in secondary care contexts. This will include cognitive behavioural models of intervention, assessment and formulation, forming a good therapeutic alliance, dealing with emotion in sessions, managing endings and service transitions, using measures and supervision and delivering group-based interventions in personality disorder.

Teaching sessions will address the most up-to-date evidence for the effectiveness of CBT PD and training in applying CBT PD in a range of care provision contexts. Clinical skills teaching will include role-play, experiential exercises and video and case demonstrations. Experiential exercises will encourage self-reflection increase in self-awareness and skill acquisition. Sessions will also incorporate a focus on therapists’ beliefs, and this module will focus on developing therapist values and therapist style to establish a therapeutic stance that is associated with good practice in the implementation of with people with psychosis or bipolar disorder.

The module is taught by experienced CBT therapists and clinical psychologists, experienced in working with personality disorder, and the content is updated regularly in line with the emerging evidence-base.

Module aims - intentions of the module

The aim of this module is to enable you to:

• Develop your knowledge of core competencies required for working with people with personality disorder, including:
  • an understanding of issues that can interfere with engagement and assessment, and an ability to manage these effectively;
  • an ability to develop an individualised formulation of the person’s difficulties, accommodating their presenting problems and psychosocial context, as a basis for therapeutic intervention aimed at personal recovery goals and outcomes;
  • evidencing an understanding of the psychosocial factors associated with risk (e.g. which increase likelihood of suicidal behaviours) including substance misuse and forensic issues;
  • an ability to incorporate these factors into an individualised formulation of the person’s difficulties;
  • an ability to implement risk management strategies, including condition specific and standalone guidance for substance misuse, and work jointly with dedicated substance misuse colleagues;
  • a critical understanding of the role of caregivers and/or supporters in supporting people with and of the impact of caregiving /supporting on both the person and the carer / supporter;
  • a critical understanding of the person’s ethnicity and culture, and the implications for clinical practice, e.g. factors that influence differences in prevalence rates reported and treatment options for ethnic groups, how cultural factors may impact the person’s experience of personality disorder, and cultural adaptations of therapies;
  • an ability to adapt clinical work for different stages in the course of personality disorder;
  • an ability to adapt clinical work for specific populations, e.g. with social and communication difficulties, different levels of cognitive ability and across the lifespan.

• Develop and update your knowledge of the fundamental principles of CBT theory, research and practice with people with personality disorder.
• Develop an advanced knowledge of core clinical skills necessary for CBT practice with people with personality disorder.

Through attending the lectures, clinical skills tutorials and supervision sessions you will develop the following academic and professional skills:

• critical analysis (the ability to critically appraise research, literature and opinions of others, and your own work in the light of data tracking and analysis)
• problem formulation and problem solving (the ability to synthesise information from theory/literature with complex data from practical experience to make sense of experience and formulate solutions)
• reflective practice (the ability to reflect on theoretical knowledge and procedural experience and to learn from this and apply learning to practice)
• collaboration (working together with others to common aims)
• managing profession relationships (including building and maintaining a working alliance, clarifying expectations, setting goals, drawing appropriately on the help and support of others, working effectively with groups, confronting issues constructively and ending working relationships positively).

Intended Learning Outcomes (ILOs)

ILO: Module-specific skills

On successfully completing the module you will be able to...

• 1. Explain the context for intervention in personality disorder and within such context provide effective CBT PD to people presenting with these problems.
• 2. Describe critically the phenomenology, diagnostic classification and epidemiological characteristics of personality disorder.
• 3. Appreciate lived experience perspectives of people with personality disorder (including those critical of mental health services), and the need for personally defined recovery goals and outcomes.
• 4. Explain critically the psychological factors in the onset and maintenance of personality disorder including the role of trauma and adversity.
• 5. Describe the current evidence based pharmacological and psychological treatments for personality disorder, the role of combined treatments, and limitations of the evidence base.
• 6. Work across multidisciplinary care contexts for the treatment of personality disorder, which interface with psychological therapy delivery, including physical and mental health care contexts.
• 7. Summarise cognitive behavioural approaches to personality disorder, their range of application, and limitation.
• 8. Engage and assess people with severe and complex presentations.
• 9. Work with people with severe and complex presentations in their social, cultural and lifespan context, and with others directly involved in the person’s wellbeing.

ILO: Discipline-specific skills

On successfully completing the module you will be able to...

• 10. Understand, critically evaluate, and apply theoretical ideas and evidence relating to specific disorders outlined in Module Specific Skills
• 11. Reflect on therapeutic skills identifying areas for personal development in relation to theoretical models of change for specific disorders as outlined in Module Specific Skills

ILO: Personal and key skills

On successfully completing the module you will be able to...

• 12. Select, organise and evaluate clinical material to produce a coherent formulation.
• 13. Reflect upon personal practice, set personal learning goals and monitor progress.
• 14. Apply and tailor knowledge of theory and practice to the treatment of individual patients through evidence of utilisation of formulation, intervention and evaluation.
• 15. Communicate understanding of theory and application to practice in written and verbal formats.

Syllabus plan

The teaching is delivered in year 2 across all terms

This module will provide an opportunity for students to develop and demonstrate a critical understanding and clinical skills in the following areas:

• Phenomenology, diagnostic classification and epidemiological characteristics of personality disorder 
• Lived experience perspectives of people personality disorder, including personally defined recovery outcomes
• Psychological factors in the onset and maintenance of personality disorder, including the role of trauma and adversity
• Current evidence based pharmacological and psychological treatments for personality disorder and the role of combined treatments
• Multidisciplinary care contexts for the treatment of personality disorder, and interfaces with psychological therapy delivery, including physical and mental health care contexts
• An overview of cognitive behavioural approaches to personality disorder
• Engagement and assessment skills for working with people with severe and complex presentations, accommodating the person’s presenting problems, risks (including any substance misuse) and psychosocial context, to develop and personalised formulation of their difficulties as a basis for therapeutic intervention
• Working with the person in their social, cultural and lifespan context, and with others directly involved in the person’s wellbeing e.g. family members
• Understanding of and ability to use a recovery oriented stance, promoting a sense of control by maintaining a focus on the client’s goals, motivations and strengths, with awareness that for some clients symptoms will persist in spite of intervention, and recognising and valuing personal recovery and maintenance of gains in this context

All sessions will include reference to literature, including research into outcome and processes of therapy.

Learning activities and teaching methods (given in hours of study time)

Details of learning activities and teaching methods

Formative assessment

Summative assessment (% of credit)

Details of summative assessment

Details of re-assessment (where required by referral or deferral)

Re-assessment notes

Two assessments are required for this module. In all cases re-assessment will be the same as the original assessment. Where you have been referred/deferred for any form of assessment detailed above you will have the opportunity to retake within four weeks from the date that feedback was provided.

If you pass re-assessments taken as a result of deferral, your re-assessment will be treated as it would be if it were your first attempt at the assessment and the overall module mark will not be capped.

If you pass re-assessments taken as a result of referral (i.e. following initial failure in the assessment), the overall module mark will be capped at 50%.

If you fail re-assessments taken as a result of referral (i.e. following initial failure in the assessment), you will be failed in the module and as a consequence you will be failed in the programme and your registration as a student of the University will be terminated.

Indicative learning resources - Basic reading

• Brief Cognitive-Behavioral Therapy for Suicide Prevention by Craig J. Bryan (Author), David M. Rudd (Author), Publisher: Guilford Press; 1 edition (24 Sept. 2018)
• Mindfulness-Based Cognitive Therapy with People at Risk of Suicide: Working with People at Risk of Suicide by J. Mark G. Williams (Author), Melanie Fennell (Author), Thorsten Barnhofer (Author), Rebecca Crane (Author), Sarah Silverton (Author), Publisher: Guilford Press; 1 edition (24 April 2017)
• Cognitive Therapy for Personality Disorders: A Guide for Clinicians by Kate Davidson, Publisher: Routledge; 1 edition (24 Aug. 2007)
• Cognitive Therapy of Personality Disorders, Third Edition by Aaron T. Beck (Editor), Denise D. Davis (Editor), Arthur Freeman (Editor), Publisher: Guilford Press; 3 edition (19 Jan. 2016)
• CBT Workbook for Personality Disorders: A Step-by-Step Program for Learning and Practicing Eight Core Skills for Change (New Harbinger Self-Help Workbook) (A New Harbinger Self-Help Workbook) by Jeffrey C. Wood, Publisher: New Harbinger; Illustrated edition (21 Jun. 2010)
• Working Effectively with 'Personality Disorder': Contemporary and Critical Approaches to Clinical and Organisational Practice by Jo Ramsden (Author, Editor), Sharon Prince (Editor), Julia Blazdell (Editor), Publisher: Luminate (6 July 2020)
• Motivational Interviewing, Third Edition: Helping People Change (Applications of Motivational Interviewing) by Miller R. William (Author), Stephen Rollnick (Author), Publisher: Guilford Press; 3 edition (5 Oct. 2012)
• Cognitive Therapy for Challenging Problems: What to Do When the Basics Don't Work by Judith S. Beck (Author), Publisher: Guilford Press; 1 edition (17 Aug. 2011)

Indicative learning resources - Web based and electronic resources

Additional Indicative Reading guidance will be given in the lectures and on ELE.

Key words search

CBT, Cognitive Behavioural Therapy, personality disorder, CBT PD