Practitioners in Community Mental Health Teams (CMHTs) frequently find that traditional forms of support are ineffective when offered to patients with personality disorder.

This book considers the various difficulties encountered, with reference to current thinking about the origins, maintenance and treatment of personality disorder. Written by practitioners for practitioners, it provides a framework for developing effective care plans with minimal use of technical terms and jargon. Rather than promote an approach based on a single theoretical model, consideration is given to ways in which different approaches can be effectively combined within a multi-disciplinary team. The book is divided into two sections. The first outlines recent government initiatives relating to personality disorder and introduces key theories underlying psychological and biological treatments. The second focuses specifically on the role of the CMHT in relation to patients with these difficulties, including:

the assessment of personality functioningdeveloping coherent plans for treatment and supportoptimising the therapeutic relationshipmanaging self-harming behaviourparticular challenges faced by CMHTs, and how to overcome themthe views of service usersinvolving family, friends and carers.

Personality Disorder and Community Mental Health Teams deals with the reality of services today. It is essential reading for all mental health practitioners in CMHTs working with people with personality disorder.

Mark Sampson works as a clinical psychologist in two Community Mental Health Teams (CMHTs) in South Manchester. He has been a part of these teams for the past five years and during this time developed experience and expertise in working with patients with personality disorder. He originally trained as a general and psychiatric nurse before studying psychology, obtaining a doctorate in clinical psychology from the University of Manchester in 1999. He uses integrative approaches to working with patients with personality disorders, but is strongly influenced by cognitive and cognitive analytic therapies.

Remy McCubbin first studied Biology at Southhampton University, graduating in 1987. He went on to study for a MA in Psychology at Nottingham University, graduating in 1993, before working on an evaluation of three CMHTs in the Midlands. In 1998 he completed a doctorate in clinical psychology, since which time he has worked across several community teams in South Manchester. This has inspired an interest in personality disorder, and has led to a recognition of the importance of such difficulties in the response to treatment of many people seen by these services. He has an interest in several forms of therapy, and the potential advantages of integrating various approaches within multi-disciplinary interventions. Away from personality disorder, he has an interest in the role of affective avoidance in the maintenance of various Axis I and Axis II disorders.

Peter Tyrer is the Head of the Department of Psychological Medicine at Imperial College, London, Honorary Consultant in Rehabilitation Psychiatry, Central North West London Mental Health NHS Trust, and Honorary Consultant in Assertive Outreach (IMPACT team) in West London Mental Health Trust. He obtained his medical qualifications at the University of Cambridge at St Thomas's Hospital London in 1965 and trained in psychiatry at the Maudsley Hospital and Institute of Psychiatry, London. He has carried out research into personality disorder since he was a medical student and has published two books and over 100 original articles on the subject. He is the founder president of the British and Irish Group for the Study of Personality Disorders and the Co-Chair of the Section on Personality Disorders of the World Psychiatric Association. He is a Fellow of the Academy of Medical Sciences, of the Faculty of Public Health, of the Royal College of Physicians, and of the Royal College of Psychiatrists. He is the Editor of the British Journal of Psychiatry and on the editorial board of seven other journals. Despite his academic interests he still regards himself primarily as a coal-face psychiatrist, who has learnt most from his patientsand among the most stimulating and challenging of these have been those with personality disorder.

About the Editors.

List of Contributors.

Preface.

SECTION ONE: THEORETICAL BACKGROUND.

1. Personality Disorder: New Initiatives in Staff Training (Eddie Kane).

2. What is Personality Disorder? (Ronald Blackburn).

3. The Causes of Personality Disorder (Nic Alwin).

4. Psychological Theories Regarding the Development of Personality Disorder (Jim Moorey, Kate Davidson, Mark Evans and Janet Feigenbaum).

5. Psychological Therapies for Personality Disorder (Jim Moorey, Kate Davidson, Mark Evans and Janet Feigenbaum).

6. Therapeutic Communities and Day Services for People with Personality Disorders (Kate Hellin).

7. Pharmacotherapy and Personality Disorders (Giles Newton-Howes).

SECTION TWO: TREATMENT AND MANAGEMENT IN COMMUNITY MENTAL HEALTH TEAMS.

8. Peoples Experiences of Having a Diagnosis of Personality Disorder (Rex Haigh).

9. An Introduction to Community Mental Health Teams (CMHTs): How Do They Relate to Patients with Personality Disorders? (Tom Burns).

10. When Can Contact with the Community Mental Health Team (CMHT) be Considered Treatment? (Remy McCubbin).

11. The Challenges Community Mental Health Teams Face in Their Work with Patients with Personality Disorders (Mark J. Sampson).

12. The Treatment Frame and the Treatment Alliance (Jim Moorey).

13. The Management of Potentially Lethal Self-Harming Behaviour (Mark J. Sampson and Gary L. Sidley).

14. Community Mental Health Teams and the Assessment of Personality Functioning (Lara Bennett).

15. Involving Family, Friends and Carers (Remy McCubbin).

16. Personality Disorder in Other Healthcare Settings (Dawn Bennett and Ian B. Kerr).

17. Clinical Supervision (Mary Shinner and Dawn Bennett).

Index.