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Cognitive Behavioural Therapy (CBT) for Personality Disorder - Theory

Module description

This module will focus on personality disorder. The module will provide a strong foundation in the evidence base for working with CBT and for personality disorder and address the most up-to-date research developments. Workshops and clinical skills tutorials will cover specific cognitive and behavioural models of psychosis and bipolar, evidence base, assessment and specialist treatment strategies. The clinical workshops will provide you with a strong foundation in the evidence base and address the most up-to date research developments. The module will be underpinned by training in knowledge and skills in a therapist stance, values and style that is consistent with good practice in the implementation of CBT with people with psychosis and bipolar.

The module is underpinned by the Roth and Pilling (2013) CBT personality disorder Competency Framework and by the National Curriculum for CBT for SMHP (NHS England and NHS Improvement, 2019).

The module is taught by experienced CBT research active therapists and supervisors, experienced in working with personality disorder, and the content is updated regularly in line with the emerging evidence-base. The module will include relevant published research carried out by the academic team into personality disorder.

Module aims - intentions of the module

The aim of this module is to enable you to:

• Develop practical competency in CBT for personality disorder, including
  • collaboratively construct maintenance formulations and treatment plans in cases of personality disorder, both alone and in relation to SMHP, taking into account client needs, goals, and preferences;
  • demonstrating use of clinical judgment in order to adapt and titrate standard interventions for common co-existing disorders and integrate them into the treatment, and to decide when and how to integrate emerging evidence with current practice, and whether, when and how to work beyond the evidence base;
  • demonstrating a task-focused approach to intervention while being sensitive to (and being directed by) the client’s needs and capacities and tolerance of emotional content, and maintaining a consistent sense of collaboration with the client.
• Develop practical skills in formulating and adapting treatment protocols in the presence of co-morbid anxiety disorders and/or depression,
• Develop confidence in articulating clinical formulations underpinned by relevant and up-to-date theory and research.

Through attending the clinical skills 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),

Intended Learning Outcomes (ILOs)

ILO: Module-specific skills

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

• 1. Understand and critically evaluate theories and models of personality disorder
• 2. Articulate the cognitive behavioural rationale for interventions offered for the client’s lived experience of personality disorder
• 3. Collaboratively and skilfully work with clients living with personality disorder, and with their families, using CBTp to reduce distress, enhance understanding, engender change, and reduce the impact of the experience on the person’s life course and their valued relationships
• 4. Work collaboratively with clients living with personality disorder on a CBTp therapy journey from engagement to ending
• 5. Formulate client lived experience, and their potential vulnerability factors and maintenance factors, within a recognised CBTp formulation/ model, and equally to evidence the ability to work with idiosyncratic formulations that are theoretical congruent with CBT PD and draw on a formulation to identify the most appropriate focus and sequence of interventions most likely achieve change, and to ensure that this sequence is congruent with the client’s perceptions of what would be most useful to them
• 6. Describe and critically analyse contemporary models for personality disorder in SMHP, their evidence bases and treatment methods derived from them
• 7. Assess the individual’s experience pf personality disorder, both alone and in the context of SMHP, taking into account clinical manifestations, co-morbidity, past history, present life situation, interpersonal and relationship functioning, and course and outcome and demonstrate the technical expertise needed in the formulation of individual cases and execution of therapy methods
• 8. Assess risk factors associated with personality disorder and integrate risk management within treatment plans
• 9. Describe commonly used assessment measures for people with personality disorder, including in the context of SMHP, including their purpose and properties, and apply outcome measures in a way that is scientifically and therapeutically appropriate, and takes into account any difficulties the client may have in completing measures
• 10. Negotiate the end of therapy and plan for long term maintenance of gains with evidence of a relapse prevention plan

ILO: Discipline-specific skills

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

• 11. Understand, interpret, critically evaluate, and apply theoretical ideas and evidence in clinical practice, supervision, and within peer learning and CPD
• 12. Analyse personal competencies and address these in relation to theoretical models of change

ILO: Personal and key skills

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

• 13. Select, organise and evaluate material to produce a coherent argument
• 14. Reflect on personal practice, to set personal learning goals and evaluate progress
• 15. Communicate understanding of theory and application to practice in written and verbal formats

Syllabus plan

The teaching is delivered in Term 2 and 3, and across university year 2 term 1 (course runs January to December across university years)

The content will include:

• Clinical application of CBT theoretical and research knowledge into clinical practice
• Becoming a Reflective Practitioner
• Therapeutic Alliance
• Challenges within therapy
• Engagement and Endings
• Sharing and working collaboratively with formulations
• Ethical written Communication
• Effective use of Supervision
• Video-recording of clinical sessions, ethics, and consent
• Psychological modelling of Personality disorder
• The phenomenology of Personality disorder including lived experience
• Theories and models of Personality disorder
• CBT PD assessment and formulation
• Using Imagery and Metaphor effectively in CBT PD
• Working with emotional avoidance and emotional dysregulation
• Working with Self-Harm and Suicidality
• Distress Tolerance
• Personality disorder and trauma
• Hearing voices
• Dissociation
• Interpersonal Challenges
• Working effectively towards change through focusing on the sense of self in Personality disorder
• CBT PD: Cognitive Interventions, Behavioural Interventions, Working with Emotion
• The uses of idiosyncratic formulating of experience, CBT PD models, and the use of theoretically underpinned protocol driven CBT PD interventions
• Evaluation of CBT PD Competency through CBT PD Clinical Supervision and the use of the CTS-R

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

Audio-visual recordings of clinical sessions are made throughout the clinical work conducted in appropriate clinic settings. Codes of Ethics [e.g. BABCP Standards of Conduct, Performance and Ethics and/or workplace Policies] are strictly adhered to in terms of making the recordings, seeking permission for use and storage of information. Signed consent forms are required to show clients have understood the reasons for and manner of recording.

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

One assessment is required for this module. The re-assessment will be the same as the original assessment. Where you have been referred/deferred for the assessment detailed above you will have the opportunity to retake within four weeks from the date that feedback was provided.

If you pass a re-assessment 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 a re-assessment 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 a re-assessment 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, CBT PD, Personality Disorder