‘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

Sequence of talk

• Service• Qualities of PD staff• Principles• Format of day• Recommendations

DeanCross

• Non forensic PD service

• MBT• Day hospital• Clinical staff of

10.8wte• 2 years old

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

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

Format of day

• Whole day

– Role play– Group – Lunch– Panel interview

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

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

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

Role play:

• A few minutes later…

Role play:

• And immediately after that…

Role play: Interview panel member

• Formulation– Coherence– Psychological and psychiatric

framework applied

• Risk Management– Balance of safe response vs

overreaction

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

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.

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?

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

Service user representative role• Critique role plays from a unique

perspective.• Ethos of collaborative working. • Difficulties of the role.

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.

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.”

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.”

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

Summary of applicant

‘thoughtful, containing, ability to think under stress, sense of

humour, willingness to hypothesise, willingness to say difficult things to staff’

Recommendations

• Duration• Multiple formats• Multiple perspectives

• Service user representative• Service user group

Discussion

• Ethics of the day