Service Users’ Experiences of Endings from NHS Community Personality Disorder Services

Webb, Kimberly Service Users’ Experiences of Endings from NHS Community Personality Disorder Services. DClinPsy thesis, University of Lincoln.

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Service Users’ Experiences of Endings from NHS Community Personality Disorder Services
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Abstract

Background: Endings are considered an important part of the therapy process,
however, the empirical literature on the topic is sparse, and clinical guidelines
supporting practice are limited. In particular, there is a lack of evidence derived from
service users’ subjective experiences that warrants further exploration.
Aim: The key aim of this research was to explore service users’ experiences of
endings from NHS community Personality Disorder services.
Method: Semi-structured telephone interviews were conducted with eight
individuals discharged within a three-month period from one of four NHS community
PD services. Interview transcripts were analysed using a deductive-inductive approach
using an adapted version of Braun and Clarke’s method of thematic analysis (2006). An
additional ‘refutational’ stage was incorporated into the steps of analysis to ensure
contrasting data was considered.
Results: During the analysis, it became apparent that there were two distinct
over-arching themes: service users’ experiences of the process of ending and their
clinical reactions and responses to the ending. It was therefore decided that two journal
papers would be written, each focussing on their respective parts. Three main themes
relevant to the process of ending were reported in paper one; ‘Service users’
experiences in the context of Reflective versus Reactive practice’, ‘Endings held in
mind’ and ‘What next?’ A further three themes emerged in relation to service users
clinical experiences of endings, ‘Loss’, ‘Responses to loss’ and ‘Boundaries’; these are
discussed in paper two.
Conclusions: In summary, service users experiences highlight the importance of
taking a reflective approach to the management of endings: in particular, explicitly
acknowledging the ending from the start, mentioning it throughout and ‘marking’ the
ending of therapy were considered key features of service users’ experiences. The
findings also highlighted service users’ readiness to end therapy as a potential area of
intervention.
The findings from the second paper emulate previous literature suggesting that
endings are experienced as a loss and that endings evoke a dynamic range of emotional
responses. Boundaries were also highlighted as having an important role in determining
how service users’ experience the loss of endings. Clinical recommendations are
provided within each paper on how health professionals and services may manage
endings within clinical practice. Suggestions for future research are also discussed.

ID Code:39304
Deposited On:23 Dec 2019 15:38

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