Team talk and personality disorder: a discursive analysis

This study's interest lay in how multidisciplinary teams talk together about clients
with a diagnosis of personality disorder (PD1 ), and how such talk relates to
professional and societal influences. Relationships to wider discourses, power
and the creation of knowledge are also considered. Historically PD clients have
held a particular role as individuals often excluded from mainstream mental
health services. Experiences of exclusion and discrimination dominate service
user accounts. There is evidence that mental health professionals and service
providers have struggled to provide a satisfactory service response, resulting in
clients receiving fragmented care. Exclusion has come to be viewed as
reasonable by practitioners. The diagnosis is considered as influenced by moral;
social, medical and socio-political influences, and has attracted controversy in
relation to its validity, reliability and usefulness. Current proposals to amend
mental health legislation and the discourse of risk contribute to the contemporary
context. The analyses explored how talk related to constructions of clients,
utilising both Discursive Psychological and Foucauldian analytic approaches
within a social constructionist epistemological framework, and gathered
naturalistic qualitative data from multi-disciplinary team meetings. Services were
all adult mental health community services in London. Three Constructions were
discussed: as clients in need of mental health service intervention; as clients not
in need of mental health service intervention and constructions of clients as
manipulative. Particular attention was paid to highlighting ways in which teams
managed and negotiated a range of professional views, with a focus on language
and the action orientation of discursive resources. These constructions were
discussed in the context of literature related to teamwork and social
psychological and psychodynamic understandings of interaction and decision
making. Clinical implications are considered for a range of interest groups.
' Please note that the term PD will be used throughout to denote clients either with an explicit or
implicit Personality Disorder diagnosis.

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