An Empowering Story: The Effectiveness of a Recovery-Focused Narrative Group Intervention for Patients with Personality Disorders

Rationale: Personality disorders (PDs) are characterized by severe impairments
in several domains of life. PDs are common in the general population as well as
in mental health care settings. There is evidence for the effectiveness and
cost-effectiveness of treatments, but only with a focus on clinical recovery of
symptoms. Very few interventions have been developed to address personal
recovery, i.e., the development of one*s personal and social identity beyond
alleviation of symptoms.

This project evaluates *An Empowering Story*, a narrative intervention focused
on personal recovery in persons with PDs. A narrative approach allows a
personalized way of working on personal recovery in three ways. It
distinguishes between a person and his or her disorder, focuses on the unique
story of each individual, and addresses how stories empower individuals in
their connectedness, hope, identity, and meaning in life. The UK Medical
Research Council guidance distinguishes four phases in the development of
complex interventions: design, feasibility, evaluation, and implementation. An
earlier project focused on design and feasibility, the current project
evaluates the intervention. The evaluation will be done in a treatment
department in a Dutch mental health institute (GGNet) with a focus on
effectiveness.

Objective: The primary aim of the current study is to assess the effectiveness
of a narrative group intervention for recovery in persons with PDs.

Study design: Multiple baseline case series design with 3-8 weeks baseline
phase, 12 weeks treatment phase and a 6 weeks follow-up phase. In addition, a
semi-structured in-depth interview is conducted with each participant after the
intervention.

The intervention: The narrative intervention *An empowering story* is offered
as a training for a group of 12 participants with 2 counselors during 12 weeks.

Nature and extent of the burden and risks associated with participation,
benefit and group relatedness: Clients will receive their usual care during the
study. The 12-week intervention is offered as an optional module including
homework, similar to other optional modules of the same duration, also combined
with homework (12*1,5 hours session plus 12*1 hours homework=30 hours in 12
weeks). Participants are requested to report twice a week, during the complete
study period, their perceived level of recovery on a visual analogue scale (max
52 times 7.5 minutes = 6.5 hours in max 26 weeks). Furthermore, questionnaires
need to be filled in four times from the start of baseline to the end of the
follow-up phase (4 times 15 minutes = 1 hour in max 26 weeks). Last, an
interview will be conducted at the end of the follow-up phase (45 minutes).
Possible risks, such as getting stuck in the (writing) process or reliving
psychological traumatic experiences, will be prevented as much as possible by
consulting the coordinating practitioner for each client interested in
participation whether this intervention is suitable and feasible for the client
in question. The expected benefits are that participants can continue their
life with a rewritten and empowering life story, which may contribute to their
personal recovery.