The mental health nurse’s understanding of the relationship difficulties experienced with male patients diagnosed with personality disorder as defined within DSM-IV

Sharp, Frank (2016) The mental health nurse’s understanding of the relationship difficulties experienced with male patients diagnosed with personality disorder as defined within DSM-IV. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

This research study utilised Q-methodology to elicit the shared perspectives of n=40 registered Mental Health Nurses (MHN) who work with men diagnosed with personality disorder (PD), represented from high, medium, and low secure environments. A literature search focused on the understanding of personality disorder, their relationship difficulties and how this is processed, to situate/contextualise the nurse participants’ results. The literature highlighted the influences on the nurses’ understanding and the therapeutic relationship, particularly concerning diagnosis, risk, role and training, and the components that impede and optimise the therapeutic alliance. The aim of the study was to explore the nurse participants’ shared perspectives regarding (1) what they understand about men diagnosed with personality disorder, (2) how Mental Health Nurses’ understand the therapeutic relationship, and (3) how understanding personality disorder and their relationship difficulties inform reflective processes. Two Q-sorts, utilising 70 and 82 statements respectively were used to elicit participants’ perspectives and were analysed using a PQ-Method 2.11 factor analysis programme. The first Q-sort created eight distinct factors for understanding personality disorder: (Factor 1: “Labels are unhelpful - look deeper”; Factor 2: “social groups and difference - gender and ethnicity”; Factor 3: “Personality disorder - a pejorative label for men and women”; Factor 4: “Beyond the mist of the personality disorder label”; Factor 5: “Personality Disorder and relationships”; Factor 6: “Personality disorder, relationships and society”; Factor 7: “Race, gender, treatment and the non-prejudicial society”; Factor 8: “Personality disorder”?). The second Q-sort created seven distinct factors for personality disorder relationships: (Factor 1: “Processing present relationships”; Factor 2: “The impact on therapeutic relationships”; Factor 3: “Relationships are consciously driven but don’t talk about the past”; Factor 4: “Coping with emotional and other responses”; Factor 5: “Coping with the ‘relationship’ and the utility of labels”; Factor 6: “The relevance of past and present behaviour, and female nursing issues”; Factor 7: “Relationship strategies, the impact and processing”) respectively from the nurse participants. In addition, emerging themes that traversed most factors revealed the following related issues pertaining to Q-sort A: (“Diagnosis and nursing assessment of personality disorder”; “Relationships”; “Features of personality disorder”; “Perceived understanding of society”; “Gender issues”; “Racial issues”; “Treatment”) and Q-sort B: (“Relationship patterns”; “The impact of personality disorder relationships on the Mental Health Nurse”; “Nurses coping strategies”; “Nurses role”; “Understanding of self”; “Processing relationship difficulties”; “Reflective practice”; “Training”). The research methodology offered a unique perspective concerning the aims, providing a foundation for a variety of future developments recommended in the discussion chapter. The above factors and the emerging themes have been interpreted, discussed, and the potential recommendations for practice have been examined. The recommendations for future practice consideration involved: functional dimensional diagnostic and nursing assessment models alongside shared formulation, personality disorder and risk, reflective practice, integrative evidence based interventions, training and support, evaluation of forensic/Mental Health Nurse competency base and role. Final recommendations concerned further research, into the relationship between personality disorder and race, and the provision of a specific reflective practice model underpinned by attachment theory.