Case Studies

Resolving Complex Trauma at Connect; A Case Study

Emily (not her real name) was severely traumatised by events in her childhood.  By the time she was in her mid-twenties, she had a long history of self-harm and had spent five years living in psychiatric hospitals.  She was diagnosed with Borderline Personality Disorder. 

Assessment

Emily was referred to Connect for assessment.  Connect has twenty years’ experience of providing a specialist service of high quality psychotherapy which supports clients to develop the emotional, psychological, practical  and social resources to live independently of mental health services.  At Connect we use the Minnesota Multiphasic Personality Inventory 2, (MMPI-2) a well-researched and reliable psychological test, for initial and continuous assessments.  Clients visit for three days before they make a commitment to move in; it is very important that a new resident actively chooses to join the community.  Emily was struck by the safe environment that Connect provides as soon as she arrived.  The psychological testing showed that Emily had very severe early developmental problems coupled with insecure avoidant attachment patterns, and as Connect has a wealth of experience in treating this kind of presentation, she was offered a place.

 Ending self-harm in a caring and responsive environment

Emily had used self-harm to cope with her often overwhelming emotions.  Like many of Connect’s clients she had very poor impulse control, often minimising or ignoring some aspect of reality.

The model used at Connect successfully supports people to stop self-harming through early interventions and intensive support.  Within the responsive environment acting out is addressed at an early stage to prevent behaviour escalating to dangerous levels.

Connect promotes the importance of building and sustaining appropriate relationships, engaging with clients and staff. Clients commit to respect each other and the structures and values of the community, to solve problems, and to support others in solving theirs. Addressing issues as they arise enables clients to build confidence in dealing with conflict effectively and encourages them to value their own contribution as well as appreciate others.

The Therapeutic Process

The culture of the community is very important in stopping self-harm; encouragement from someone with direct experience of the same problems is a strong motivator for change.

Once Emily had made a commitment to keep herself safe and not self-harm to deal with her difficult feelings, she was able to use the support available at Connect to meet her underlying needs.

Daily group and individual therapy was provided by qualified and experienced Psychotherapists. Clinical staff are qualified in a range of modalities including, Transactional Analysis, Person Centred, Integrative Psychotherapy, Drama Therapy and Gestalt Therapy.

Emily’s progress in therapy was continuously assessed every 6 months using the MMPI-2 test.  Emily says the best thing about Connect was "feeling cared about.  Initially, just getting the sense of safety was amazing, because I hadn't had it anywhere."

Clients are in charge of their own process; they agree a contract for therapy which gives them responsibility for making important changes to their lives.

The role of psychiatric medication

When Emily arrived, she was taking large doses of psychiatric medication, which were safely dispensed to her at Connect.  The January 09 NICE guidelines for Borderline Personality Disorder emphasise that the role of psychiatric medication should be strictly limited: “Drug treatment should not be used specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorder.” (NICE 2009).  This corresponded with Connect’s approach; drug treatment may have provided Emily with symptomatic relief in the short term, but did not effect change to the underlying issues. Emily worked in therapy to reduce her reliance on medication; now all she takes are vitamins.

Moving to Independence

When Emily finished her residential placement at the community, Connect helped her to find her own accommodation and she became a day member, attending therapy a few days a week on a reducing schedule.  This gave her the support she needed to adjust to living in the wider community.

Now completely independent of statutory services, she is in employment and has recently been accepted onto a nursing degree course.