the day was bloody impossible – but i got something out of it. selecting the right person for a pd...
DESCRIPTION
Speakers: Dr Tennyson Lee and Claire Ellingford. First National Personality Disorder Congress, Birmingham, 19-20th November 2009.TRANSCRIPT
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‘A bloody impossible day’
Selecting the ‘right’ person for a PD service
Tennyson Lee*, Claire Ellingford**, Elizabeth Bishop*, Nikolas Ragiadakos*, Martin Kelly**, Samantha Blackburn** DeanCross Personality Disorder Service** Tower Hamlets Service User Involvement
Project
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Sequence of talk
• Service• Qualities of PD staff• Principles• Format of day• Recommendations
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DeanCross
• Non forensic PD service
• MBT• Day hospital• Clinical staff of
10.8wte• 2 years old
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Qualities of PD staff Bateman and Fonagy (2004) • maintain boundaries whilst offering flexibility • surviving hostility without retaliating • managing internal and external conflict • effective team players, comfortable in a MDT,
not insist on strict professionally determined demarcation of tasks
• assess threats of suicide without anxiety • deal with emotional storms with reflection • robust but flexible demeanour
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Rationale for our approach
• Expose applicants to challenges they could expect in the post
• Main themes:• Dealing with anxiety• Teamwork, incl conflict• Risk assessment• Psychological and psychiatric approach
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Format of day
• Whole day
– Role play– Group – Lunch– Panel interview
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Role play: Instruction to applicant
• Assess a patient referred to the PD service
• Read referral letter• Assess patient (15 mins)• Interview by panel member (10 mins)
– Formulate patient’s difficulties using an appropriate model
– Outline your management plan
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Role play: Letter
– P/C: • Depressive symptoms and DSH thoughts• Erratic, at times intensive use of service
– Past history• Many overdoses and admissions• Previous dxes include depression, anxiety
disorder, borderine PD
– Please assess
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Role play:marking memorandum
1. Information gathering2. Identify important early and later
experience3. Identify P/C and use of defences4. Management of –ve transference5. Formulation of above info6. Mx of risk
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Role play:
• A few minutes later…
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Role play:
• And immediately after that…
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Role play: Interview panel member
• Formulation– Coherence– Psychological and psychiatric
framework applied
• Risk Management– Balance of safe response vs
overreaction
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Group• Interaction between candidates and
roles taken. • Their capacity to use the group
productively. • Ability of candidates to express feelings
on the role play in an authentic way. • Candidates managing their feelings of
competitiveness and transference.• Interaction between candidates and
facilitators
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Lunch
• An informal space to meet with current staff members.
• Two way interaction. • An opportunity for candidates to
ask questions about DeanCross. • Feedback from staff to panel.
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Panel Interview Questions for candidates
• What qualities make you suitable for working in a PD service
• What qualities may make you less suitable for working in a PD service
• What are your reflections on the role play?• Scenario: conflict between psychiatrist and therapist• What are your thoughts on having a Service User
representative present?
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Panel interview
• Candidate’s reflection on previous parts of the day.
• Assessment of candidate’s authenticity.
• Interactions with individual panel members. – Service User Representative – Psychiatrist
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Service user representative role• Critique role plays from a unique
perspective.• Ethos of collaborative working. • Difficulties of the role.
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Focus group with staff
• Feedback from current staff members.
• Discussion on all aspects of the interview process.
• Overall feedback was positive with acknowledgement that it was a challenging day.
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Focus group with staff
Quotes from staff:“It’s harder to get a job on a wing and a
pray in this sort of system. You are very much seen and on show and exposed.”
“Its about being rather than being able to talk the talk, its about how you are.”
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Interview with actor• Actor’s experience of the role play. • Thoughts on key aspects of:
– Trust: “that was just with my gut… you just know and I think that was the easiest one for me to gauge… It didn’t matter to me how good bad or indifferent they were, how they scored – it was just something I felt just a human to human response. – Its about trust really.”
– Engagement: “I don’t want to feel from the person also that I’m just a number, that I’m yet another one that you’re doing – its mater of fact – it felt very personal and very key to me.”
– Anxiety “…if I’m getting that sense, that fear [from the candidate], when I was in patient mode that wasn’t very reassuring.”
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Illustration: who to appoint?
Applicant 1 Applicant 2
On paper excellent acceptable
role play Risk assessment ? Poor
Group good good
Lunch Nil exceptional Nil exceptional
Panel interview ArticulateRisk assessment Not processConflict qu: collapsed
GoodHonest re missed risk assessmentConflict qu: stood ground
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Summary of applicant
‘thoughtful, containing, ability to think under stress, sense of
humour, willingness to hypothesise, willingness to say difficult things to staff’
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Recommendations
• Duration• Multiple formats• Multiple perspectives
• Service user representative• Service user group
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Discussion
• Ethics of the day