Development of a Combined Group and Individual Intervention to Promote Work Integration and Job Tenure for People With Borderline Personality Disorder

PURPOSE: Work participation is a documented occupational challenge for people with borderline personality disorder (BPD) influenced by personal, occupational as well as environmental facilitators and barriers (Dahl, Larivière, & Corbière, 2017, Larivière et al., 2010, Cramer et al., 2006). Currently, there is no comprehensive intervention for this clientele regarding work reintegration and job tenure. Only a few suggestions of interventions have been published (Comtois et al., 2010; Elliott & Konett 2014; Koons et al., 2006). They mainly consist of additions to evidence-based psychotherapies. Findings from these studies show the relevance of developing specific interventions about work participation (Comtois et al., 2010; Elliott & Konett 2014; Koons et al., 2006). The goal of this project is to develop an original intervention combining a literature review, clinical expertise and lived experiences of persons with BPD to be eventually delivered by occupational therapists.

DESIGN: To design this intervention program, a logic model was first created (Chen, 2015), combining a literature review and focus groups with occupational therapists and mental health practitioners from different clinical and community settings in Quebec (n = 16). In addition, four middle aged women with BPD participated in individual qualitative interviews to better understand their needs and suggestions for a meaningful therapy program about work reintegration and job tenure. All the interviews were audiotaped and transcribed. The analyses combining the literature and interview findings served to organize the logic model, including characteristics of the target clientele with BPD; issues to be addressed; most effective activities to attain program goals; content to be included; who would deliver this intervention, etc. The intervention manual derived from the logic model was developed by the researchers (two occupational therapists and one work counsellor) and was validated by all participants by providing written feedback.

RESULTS: The intervention combines nine group and two individual sessions over a 12 week period. It aims to help persons with BPD improve their self-knowledge, self-esteem and sense of competence as a worker, have a deep understanding of what work means to them, learn workplace tools and strategies to better manage their professional activities, have a more diversified routine and improve life balance and finally, improve the fit between the future job and the person. The overall approach is integrative combining psychological, occupational and andragogy perspectives as well as therapeutic group best practices. Sessions incorporate strategies such as projective methods, reflective questionnaires, work environment simulations, role playing, group discussions and homeworks. Examples of themes are meaning of work; relationship with the boss; disclosure of diagnosis; optimal engagement at work; diversity of occupations outside work.

CONCLUSION: This project represents the foundations of a promising and original intervention program which is personalized to the needs of individuals with BPD. A mixed method pilot validation with two groups of persons with BPD is the next phase of this study to examine its effects.

References

Dahl, K., Larivière, N. & Corbière, M. (2017). Work participation of persons with borderline personality disorders: A multiple case study. Journal of Vocational Rehabilitation, 46, 377-388. https://doi.org/10.3233/JVR-170874

Chen, H.T. (2015). Practical program evaluation: Theory-driven evaluation and the integrated evaluation perspective (2nd ed.).Thousand Oaks, CA: Sage.