Abstract：
Therapeutic relationships play a central role in maintaining a positive social climate in forensic settings. The interpersonal difficulties characteristic of Borderline Personality Disorder, alongside the secure environment of forensic wards, can make developing positive therapeutic relationships with this patient group challenging. Qualitative interviews aimed to explore how ward staff understand and experience the interaction of interpersonal relationships and social climate when caring for patients with Borderline Personality Disorder on forensic wards. Interviews with 11 staff members working across UK forensic inpatient settings were analysed using Reflexive Thematic Analysis and reported following COREQ guidelines. Six interrelated themes were generated; three describe relational cycles that occur between ward staff and patients with Borderline Personality Disorder and three describe systemic factors that influence the context in which ward staff operate. From these themes, an integrative model was developed to summarise how factors in the wider forensic system and the interpersonal relationships between staff and patients with Borderline Personality Disorder in forensic wards influence one another, affecting staff experiences of the social climate of forensic settings. The model illustrates how complex cycles within the therapeutic relationships with staff and patients with Borderline Personality Disorder can interact with systemic influences in the wider forensic context to influence staff experiences of forensic settings. Clinical implications of the model are discussed, offering recommendations for improving therapeutic relationships and the social climate on forensic wards caring for patients with Borderline Personality Disorder, to better support staff and patient wellbeing.
摘要：
治疗关系在维持法医环境中的积极社会氛围中起着核心作用。边缘性人格障碍的人际交往困难特征，除了法医病房的安全环境，可以使与该患者组发展积极的治疗关系具有挑战性。定性访谈旨在探讨在法医病房照顾边缘性人格障碍患者时，病房工作人员如何理解和体验人际关系和社会氛围的相互作用。使用自反主题分析对在英国法医住院环境中工作的11名工作人员的访谈进行了分析，并按照COREQ指南进行了报告。产生了六个相互关联的主题；三个描述了病房工作人员与边缘性人格障碍患者之间发生的关系周期，三个描述了影响病房工作人员工作环境的系统因素。从这些主题来看,开发了一个综合模型，以总结更广泛的法医系统中的因素以及法医病房中边缘性人格障碍的工作人员和患者之间的人际关系如何相互影响，影响工作人员对法医环境社会风气的体验。该模型说明了与边缘性人格障碍的工作人员和患者的治疗关系中的复杂循环如何在更广泛的法医背景下与系统影响相互作用，以影响法医设置的工作人员经验。讨论了该模型的临床意义，为改善法医病房护理边缘性人格障碍患者的治疗关系和社会氛围提供建议，更好地支持员工和病人的福祉。
