Working with personality disorder, severely ill and complex patients

Course overview

This programme presents an opportunity for qualified psychotherapists/analysts to join the Fitzjohn’s unit at the Tavistock and Portman NHS Foundation Trust to learn about and to participate in our approach to patients suffering with severe personality disorder, borderline states and psychotic illness.

Course members will be based in the Fitzjohn’s unit, a specialist unit, where they will attend unit meetings. In addition, they will take on the treatment of at least one patient. They will receive supervision by a senior member of the unit in a small group and may attend the Fitzjohn’s clinical seminar led by Mrs Edna O’Shaughnessy.

This course is suitable for psychoanalytic psychotherapists registered with BPC or equivalent.

To begin your application please email Birgit Kleeberg a copy of your CV. If you are successful at this stage you may be invited for interview to assess personal suitability. 

This is a rolling programme and you can apply at any time during the year, except August.

The Fitzjohn’s approach to personality disorder and severe mental illness

The Fitzjohn’s Unit is a specialist outpatient service for patients with complex needs including personality disorder. It is located within the complex needs branch of the Specialist Adult Mental Health Services (SAMHS) at the Tavistock and Portman NHS Foundation Trust.

What our patients suffer from

Patients treated in the unit do not fit a single diagnostic group, but display and suffer from severely disorganised mental functioning. They often experience major breakdowns in relationships, work and education. They are likely to suffer from severe depression, anxiety, suicidality, self-harm, impulsive behaviours or eating disorders, such as anorexia nervosa and bulimia. Some patients have established mood disorders (eg bipolar affective disorder), and some will have experienced psychotic episodes. Often the patients who come to us are regarded as being ‘hard to help’ and have difficult or anxiety-provoking relationships with other services and community mental health teams. Some have experienced exclusion from mental health services, making it difficult for them to get help.

The need for a significant length of treatment

An important part of our approach derives from an understanding that patients with personality disorders and other severe mental health problems need a significant length of treatment to provide sufficient containment for a developmental process to take place. We offer assessment, consultation and treatments, individually tailored to each patient and to the context of each referring service. Most often, we offer twice-weekly individual psychotherapy for two years, followed by the possibility of group therapy for a period of several years. We liaise closely with referrers throughout treatment, but expect that, during the time patients are in the unit, there is only limited active use of other services.

What constitutes an effective treatment programme

An extensive review of the available evidence concludes that effective psychotherapy treatment for this patient group should:

  • be well structured
  • devote effort to achieving adherence
  • have a clear focus
  • be theoretically coherent to both therapist and patient
  • be relatively long term
  • be well integrated with other services available to the patient
  • involve a clear treatment alliance between therapist and patient

Our treatment model exemplifies these guiding principles.
The broadest aim of our treatment approach is to help patients to explore how their past difficulties affect current functioning, leading to repeated and counterproductive ways of managing, thereby broadening the possibilities available to them and promoting emotional development.

The course will require weekly attendance of group supervision, reading seminars, clinical seminars and twice-weekly individual psychotherapy with one patient for two years.

The course will take place every Friday, 11.30am-3.15pm.

  • 11.30am-12.45pm - Weekly clinical seminar with Mrs O'Shaughnessy (optional)
  • 12.50pm-2.00pm - Weekly Fitzjohn’s unit meeting (compulsory)
  • 2.05pm-3.20pm - Weekly small group supervision / monthly reading seminar (compulsory)
  • Two x 50 minutes - Clinical work with one twice-weekly patient (compulsory)

This continuous professional development (CPD) programme is suitable for psychoanalytic psychotherapists/psychoanalysts who would like to:

  • deepen their clinical experience and understanding of working with more disturbed patients who are difficult to help
  • develop understanding of disturbing countertransference experiences which characterise the work with this patient group
  • participate in the work of an established specialist unit in an NHS setting
  • develop expertise with the management of higher risk, complex patients who require ongoing liaison with psychiatric services and community mental health team (CMHT) input
  • consider ethical issues such as confidentiality and dealing with complaints which often arise in this kind of work

£1500 per year

Trust Certificate
Course length:
10 months
The Tavistock Centre, London
Admission status: