Exploring the experience of direct care staff working with adults with learning disabilities who have a diagnosed borderline personality disorder

Section 1. Literature Review - Aim: To review the literature relevant to staff’s experiences of working with people who have learning disabilities, who display challenging behaviour. Method: A computerised literature search was conducted using various databases. Results: Staff working with people who have a learning disability and who display challenging behaviour experience negative emotions. The literature regarding challenging behaviour and staff’s experiences may benefit from incorporating existing research regarding the impact of organisational factors and the patients’ mental ill health upon staff’s experiences. Discussion: Methodological limitations in the existing research are discussed and future research ideas are proposed to enable a more holistic understanding of direct care staff’s experiences. Section 2: Research Report - Aim: To explore the experiences of staff who have worked with learning disabled patients who also have a diagnosed borderline personality disorder. Method: A free association narrative interview approach was used to analyse the accounts of eight direct care staff (Hollway & Jefferson, 2000). Results & Discussion: Working with patients who have a learning disability and a diagnosed borderline personality disorder is emotionally demanding. Participants did not appear comfortable in sharing their personal emotional experiences. It was thought this was because these were very painful and staff were concerned they would be criticised for voicing negative feelings about these patients. Staff appeared to manage their painful emotional experiences of their work by using a number of psychological defence mechanisms. These included projecting and expressing their negative feelings onto the organisation, and/or by trying to forget and repress these negative experiences. Conclusion: Organisational factors can be problematic and need to be addressed to reduce the obstacles staff experience in their work with patients who have a learning disability and also a borderline personality disorder. However, when staff comment upon these organisational factors they may also be indirectly expressing the emotional impact these patients are having upon them. Once the organisational factors have been addressed staff may begin to feel more supported and safe enough to being to explore the painful emotional reactions they have experienced in their work with their patients without the fear of being criticised by others. Section 3: Critical Appraisal - Critical reflections upon the research methodology and process are provided.