Dr. Emma Smith
Dr. Smith is a consultant clinical psychologist working in Sussex Partnership NHS Foundation Trust, and privately with the Chelsea psychology clinic in London. She is trained in several specialist therapies including Mentalisation Based Therapy, Schema Therapy and EMDR. She was leading a Tier 3 personality disorder service when the pandemic hit and had to lead changes to support vulnerable service-users at this difficult time. This inspired her to research the experience of delivering group therapy online with service-users who have a diagnosis of personality disorder in order to learn how best to enhance engagement and attend to the relational difficulties that arise.
Enhancing engagement in virtual therapy with people who have a diagnosis of personality disorder.
Background: Drop-out rates from evidence-based interventions for people with a diagnosis of personality disorder (PD) are high. The COVID-19 pandemic has likely exacerbated barriers to engagement with the introduction of virtual working. Virtual therapy has a good evidence-base for Axis I disorders, but limited research for Axis II disorders.
Aims: To investigate facilitators and barriers to engagement in a Tier 3 PD service virtual group programme.
Method: A virtual group programme was developed in collaboration with service members, and analysed members' attendance rates over a 5-month period pre- and post-COVID-19. Thematic analysis of semi-structured telephone interviews with 38 members is reported, describing their experience of the virtual group programme.
Results: Attendance rates were significantly higher pre-COVID (72%) than post-COVID (50%). Thematic analysis highlighted key barriers to attendance were: practical issues, low motivation, challenges of working in a group online and feeling triggered at home. Main promoters of engagement were: feeling valued, continued sense of connection and maintaining focus on recovery.
Discussion: The results suggest that the pandemic has exacerbated relational and practical barriers to engagement in a Tier 3 PD service. Ways of enhancing engagement are discussed, as well as preliminary recommendation for services offering virtual therapy to people with a diagnosis of PD.
Keywords: COVID-19; attendance; engagement; group therapy; online therapy; personality disorder; virtual working.
Implications: We will discuss implications for working with people who have a diagnosis of PD virtually in both group and individual therapy.