The efficacy of psychological therapy is highly correlated with the overall treatment approach which both informs and is informed by the Psychological formulation approach. As such, treatment goals and evaluation are a highly collaborative and integrated process which combine a number of complex interrelated factors. Over the past year, there have been several positive outcomes for patients who have been receiving psychological therapy as a core component of their overall treatment. Given the unique nature of this setting and the complexity of the clinical conditions which are being treated, positive outcomes and success stories are not necessarily about recovery. Frequently, maintenance of core processes or establishing a foundation which can enable someone to move to the next stage of their treatment are valuable and important outcomes.
Some of the positive therapeutic outcomes are identified below:
Ø ML – following an intensive course of treatment, ML's extremely complex presentation which was associated with her diagnosis of Dissociative Identity Disorder, became far less challenging and she was able to change from being on 2:1 observations to being discharged from her Section and finally being discharged from the hospital into supported accommodation. The three phase treatment approach for DID (stabilization, trauma processing and integration) was adopted successfully by the whole team.
Ø RJ – having been in services for over 20 years following an acquired brain injury and organic personality disorder, RJ exhibited severe difficulties with her mood and with anger management. In combination with Art Psychotherapy sessions, RJ received weekly Clinical Psychology sessions for over two years, during which time she gained a clear understanding of her mood patterns, developed positive coping strategies for managing low mood and overwhelming thoughts and feelings and achieved greater confidence, enhanced self-esteem and a more hopeful view of her future. R was able to move from hospital to supported accommodation.
Ø TJ – presenting with complex trauma-related symptoms, an atypical eating disorder and severe attachment difficulties with associated suicidal thoughts and behaviour, T has required intensive care and treatment for several years. Whilst there has been minimal change in her fundamental sense of hopelessness and wish to end her life, there has been a gradual but substantial change in the quality and nature of her attachments, her perceived relational security, her capacity for self-soothing and self-direction and her acquisition of coping skills. An example of a concrete change, has been her shift from being fed by a gastric PEG tube to independently maintaining her weight and BMI in an acceptable range.
Ø AG – engaged with psychological therapies (Clinical Psychology, Art Psychotherapy and sessions with Assistant Psychologist) on a regular and consistent basis from the beginning of her admission to JMH. Although she continued to display repeated crises, involving deliberate self harm, absconding and aggressive behaviour, A made a number of significant and impressive gains in terms of developing awareness of her thoughts, feelings and behaviour, acquiring coping skills and processing past trauma. The schema focused approach was integrated into A's psychological therapy and into her wider care and treatment. As such, ward staff were extensively trained in the application of this model and were beginning to be able to use this effectively with A. Unfortunately, the nature of the crises associated with her diagnosis (Emotionally Unstable Personality Disorder) and presentation were not able to be managed by the clinical team and A was transferred to a PICU with a view to identifying a more specialist therapeutic unit for her.
Ø LM – was rediagnosed with Dissociative Identity Disorder during psychological assessment, following a long history in mental health services and a range of different diagnoses. Presented with a history of serious and impulsive self harm and suicidal behaviour, which continued to feature in her presentation during the first year of her admission to JMH. Treatment was provided within the DID framework over three and a half years (intensive sessions of both Clinical Psychology and Art Psychotherapy) and resulted in a gradual reduction of symptoms and challenging behaviour, such that L was able to come off 2:1 observations, was discharged from her Section 3 and was recently was discharged into the community (Shared Lives project). The progress and recovery made by ML was remarkable.
Ø WA – with a chronic and long-term history of extremely high risk behaviour and highly destructive interpersonal patterns, W engaged well with Clinical Psychology and Dramatherapy. Through her therapy, she was able to achieve greater stability in her behaviour, process past trauma and develop a more integrated sense of self. She was recently discharged from hospital into supported accommodation.
Ø NC – initially responded very well to intensive therapeutic input and an integrated, formulation based approach, such that her interactions became warmer and more insightful, she was working hard on processing past experiences and had greater hope and motivation for the future. Unfortunately, the constant absence of funding support for practical and much needed equipment and resources (e.g. a motorized wheelchair, neck brace, physiotherapy) has frequently undermined the value of the therapeutic input she has received and led to a deterioration in her mental and physical health.
Ø SB – with a diagnosis of Emotionally Unstable Personality Disorder and an atypical Eating Disorder and a history of severe and frequent self-harm and suicidal behaviour, S was an extremely challenging and complex client. However, during her admission, she was able to reduce the degree of her avoidance and engage in a more open and trusting manner, developing positive attachments with several members of the team. Ultimately, this led to S being sufficiently stable to be transferred to a specialist unit where she would have the opportunity to engage in a more intensive individual and group therapy programme.
Dr Lisa Nolan, Clinical Consultant Psychologist at the John Munroe Group.