Table 1 Views of expert panel and their impact on the design of the active intervention

Name of the intervention

• Avoid using the term 'brief' which may give the impression the person does not have serious problems.

• The word 'support' was preferred to the words 'intervention' or ‘treatment’ as this recognises that people are receiving help to better self-manage rather than something that happens to them.

Decision to call the intervention ‘Psychological Support for Personality’.

Target group

• To try to keep this as broad as possible, because many people with personality disorder are excluded from services due to coexisting conditions.

To make the intervention available to people with coexisting, non-psychotic, axis I disorders including alcohol and drug misuse.

Number of sessions

• Should generally offer six to 10 sessions.

• The panel recommended that no minimum or maximum number of sessions be set.

That the therapist and service user agree the number of sessions to be delivered following the initial assessment - but (in general) to offer six to 10 sessions.

Contact outside of sessions

• The panel recommended that limited telephone contact in times of crisis could be beneficial as general crisis support lines were often experienced as unhelpful.

• Service user members expressed the view that telephone-based sessions were not likely to be as helpful as face-to-face meetings, but felt that telephone-based sessions should be offered as an alternative to face meetings if this was the service user’s preference.

To offer limited access to telephone support at times of crisis.

Sessions to generally be offered face-to-face with the option of telephone based sessions if service users prefer this.

Missed sessions

• Service users felt that, if advance notice was given, people should be allowed to re-schedule sessions; clinicians agreed with this but felt that a limit needed to be placed on the number of sessions that could be cancelled.

The therapist should reschedule session(s) if asked to do so by the service user.

Missed sessions may be substituted, therapists should use discretion when deciding this.

Provision of group-based sessions

• Concerns were expressed about the impact of isolated peer group sessions in the context of a short term individual intervention.

• There was a consensus that it would be appropriate to refer people to community-based groups and other resources if these are available.

Not to incorporate group sessions within the intervention, but to refer service users to community-based groups outside of the intervention if these are available.

Use of diagnostic term ‘personality disorder’

• Two thirds of the group were in favour of the use of the term and a third were not, unless discussion was initiated by the service user.

• All agreed that providing information about personality and personality-related problems was an important part of the intervention.

• The group recommended the use of a shared formulation to give people a framework for trying to understand their problems and what might help them.

The intervention includes a discussion of personality and the origins of personality-related problems. The intervention includes the development of a shared formulation.

Personality disorder diagnosis is discussed but only used if the person finds this helpful.

Liaison with primary care

• Service user members stated that the extent to which details of the intervention were shared with their GP should depend on the quality of their relationship with them.

• Most staff members of the group stated that information about the intervention should be shared with the GP.

Copies of the shared formulation and final discharge plan will be shared with the service users GP if they agree to this.

Medication

• Clinicians stated that it would complicate the intervention to include a routine review of medication.

• Service users expressed a preference for including a review either before the intervention or at an early stage.

• All participants were concerned about the impact of side effects of medication on peoples’ health.

To offer a review of medication to those who are concerned about the psychotropic medication they are taking.

Involving significant others

• Panel members agreed that this could be helpful but emphasised the importance of ensuring that this was what the service user wanted and making sure that service users did not feel left out of any joint sessions.

To offer a joint meeting with a significant other if the service user would like this.

Treatment goals

• All members supported the development of person-centred aims for the intervention.

• Service users members stated that the word 'goals' was not ideal and may inadvertently lead people to focus on what they had not achieved during the intervention.

• There was general agreement about the need to manage expectations and having flexibility in reviewing progress during the intervention.

Therapists to ensure that service users are provided with information about the limited focus of the intervention.

Service users and therapists to agree a shared focus (generally by the end of the second session).

Psychological approaches

• Service users members emphasised the importance of psychoeducation to help people understand and cope with stigma and self-stigma.

• Members of the panel stated that other approaches such as mindfulness and problem-solving could be beneficial depending on the person’s individual needs.

Psychoeducation to be the starting point for the intervention.