Impact and feasibility of online training for high intensity therapists treating clients with personality difficulties: a mixed method study

Abstract NHS Talking Therapies (TT) is England’s main service for treating people with common mental disorders. Prior research has shown that a high proportion of people receiving TT ‘high intensity’ treatment have concurrent personality difficulties and that these are associated with poorer TT treatment outcomes. We developed a training workshop to enhance the skills, knowledge, and confidence of TT therapists in the treatment of this population and conducted a mixed methods evaluation to investigate whether the training was acceptable to staff and whether it had any impact on client outcomes. A quantitative survey ( n =46) and qualitative interviews ( n =6) were undertaken with staff and in parallel, we analysed the anonymised health outcomes of two client cohorts, treated pre-training ( n =2434) and post-training ( n =2358). Multi-level, difference-in-differences analyses revealed statistically significant cohort differences between the last and first scores on the domains of depression (–2.53, 95% CI: –3.02, –2.04), anxiety (–2.70, 95% CI: –3.15, –2.20), social functioning (–2.17, 95% CI: –2.88, –1.47), and phobia (–1.19; 95% CI: –0.29, –0.17). Therapists reported finding the training helpful, particularly in managing therapeutic alliances and enhancing the interpersonal effectiveness of their clients. Furthermore, the survey revealed a positive change in therapist attitudes to, skills related to, and knowledge of personality difficulties post-training. However, staff also suggested that broader structural changes and more resources are needed for TT services to better support clients with personality difficulties. Training initiatives such as this appear to be feasible and helpful for therapists, and may help to optimise client outcomes. Key learning aims (1) To understand the potential utility of online training for therapists, in their management of clients with concurrent personality difficulties. (2) To understand high intensity therapist perspectives on attending a workshop to support tailoring treatments for depression and anxiety in the context of personality difficulties. (3) To reflect on enhancing treatment for clients with personality difficulties via training workshops.