Joint working

Although it is advisable to keep the number of therapists to a minimum in the care of those with personality disorder, there are disadvantages in having a lone therapist. This has led to problems in implementing the Care Programming Approach, (65> especially when the worker is less experienced. Planned sharing of cases between two or three therapists, each with a clearly demarcated role, helps to maintain a treatment programme. (H>

Perhaps the most important error in management is failure to recognize personality disorder when other psychiatric disorders are more prominent and may seem to be the only presenting problem. This is becoming recognized in the development of treatment protocols. This problem is encountered widely in the mental health services among people presenting to emergency psychiatric clinics, (.66> in services for the homeless mentally ill, (67> and among heavy users of psychiatric services(68) and those with multiple admissions/69) In all these settings, personality disorder is often not recognized early enough. This is to some extent understandable as the assessment of personality disorder is difficult in, for example, a busy emergency clinic. Nevertheless, failure to achieve a predicted response is often due to an earlier failure to detect the presence of personality disorder.

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