Les personnes ayant un trouble de la personnalité borderline (TPB) présentent des problèmes professionnels. Le modèle Individual Placement and Support (IPS) de soutien à l’emploi a montré son efficacité mondiale pour réinsérer des personnes présentant des troubles mentaux sévères. Son bénéfice pour les individus avec troubles de la personnalité reste sous-étudié. Les job coaches IPS ont du mal à gérer ces personnes. Le Good Psychiatric Management (GPM) pour le TPB, méthode thérapeutique basée sur les preuves, applicable dans tout cadre psychiatrique, pourrait faciliter les pratiques des job coaches et l’obtention de meilleurs résultats pour les clients. Dans une étude parallèle, les équipes IPS trouvaient cette combinaison positive. L’objectif de cette étude de cas multiples était d’explorer l’expérience des clients IPS avec des job coaches formés au GPM.

Les équipes IPS du canton de Vaud (Suisse) ont été formées au GPM en janvier 2022. Six de leurs clients avec TPB ont participé à des entretiens de recherche sur leur opinion de l’intervention. Une analyse de contenu abductive a été réalisée. Des données quantitatives ont été récoltées à trois moments. L’évolution des participants a été analysée descriptivement, en lien avec leur discours.

Les clients étaient globalement satisfaits de l’intervention et la recommanderaient, suggérant quelques améliorations. L’intervention les aidait dans leur rétablissement et leurs objectifs professionnels.

L’intégration du GPM dans IPS est appréciée par les prestataires mais aussi par les utilisateurs. Ces résultats sont prometteurs pour la réinsertion professionnelle des personnes avec TPB. Les conclusions méritent confirmation par de plus larges études contrôlées.

People with borderline personality disorder (BPD) often present occupational issues, such as impulsivity, conflicts in the workplace, dismissals and unemployment. Several psychosocial programs have been recently developed to tackle this issue but need more evidence for their value, and require rather a lot of resources for implementation. The Individual Placement and Support (IPS) model of supported employment has shown its international effectiveness in professionally reintegrating people with severe mental illness, and is well established throughout the world. This model responds to a principle of zero exclusion regarding any kind of disorders if they are being treated. However, its value for individuals with BPD remains largely understudied. IPS job coaches find it difficult to deal with people with this disorder and could benefit from an additional feature to help them in this sense. Good Psychiatric Management (GPM) for BPD, an evidence-based therapeutic method, applicable in any psychiatric setting, could be a solution for easing job coaches’ practices and reaching more satisfying results for clients. A one-day training is enough to show a change in healthcare attitudes towards BPD. In a previous study, IPS teams seemed to find this additional feature valuable and feasible.

The aim of this multiple case study was to explore clients’ experiences of the IPS intervention with GPM-trained job coaches.

IPS practitioners of the RESSORT unit of the Community Psychiatry Ward of Lausanne University Hospital and the Nant Foundation, Vaud, Switzerland, were trained in GPM in January 2022. Six of their BPD clients took part in research interviews, around 9 months later, addressing their experience and opinion about the intervention. An abductive content analysis was conducted, using the characteristics of an efficient GPM intervention as a theoretical background to classify elements that were or were not fitting GPM success. In parallel, quantitative data from these clients, including their professional path during the intervention, and questionnaires for non-vocational outcomes, were collected at three time points, when they entered the study, 3 months and 9 months later. Their evolution through time was analysed descriptively and linked to their discourse.

Service users were globally satisfied with the intervention, built a certain level of stability and an alliance with their job coach, and would recommend participating in the program. Job coaches seem to have adopted the main GPM principles. Judging by the discourse and evolution of the participants, the intervention seemed to help them in their recovery and professional goals. Most of them had a stable or improving symptoms level and found an activity at post-test.

These results also suggest some additional improvements: more clarity about the intervention framework, a BPD specialised treatment outside of IPS, and continued applications of IPS principles to potentiate the positive effects of combining both interventions. The integration of GPM in IPS is appreciated not only by the providers but also by the users.

These first results seem promising for the professional reintegration of people living with BPD. The present conclusions should be confirmed through larger-scale controlled studies, and compared to other specialised rehabilitation programs for BPD.