Principles of nidotherapy in the treatment of persistent mental and personality disorders.
BACKGROUND
The principles of a psychological intervention for psychiatric disorders, nidotherapy, are described following its use in the treatment of patients with severe mental illness, most of whom also have personality disorders. Nidotherapy is the collaborative systematic assessment and modification of the environment to minimise the impact of any form of mental disorder on the individual or on society. It is particularly appropriate to consider for chronic and recurring disorders in which there is no prospect of short-term improvement.


METHODS
An analysis of the treatment suggests its main tenets are the development of a joint consensus (collateral collocation) of environmental change needed, formulation of targets, consequent monitoring and adjustments made to test the effectiveness of intervention, and a joint structure (arbitrage solving) to adjudicate when changes are considered feasible or impractical by one party and not the other.


RESULTS
Case vignettes are used to describe the main features of the treatment. Although nidotherapy includes some of the elements of cognitive, occupational and family therapy, and even social work, it is different in that it focuses on changing the environment, not the person. It is therefore much more acceptable to those patients who have repeatedly challenged the justification of conventional therapy for their conditions.


CONCLUSIONS
Nidotherapy deserves further enquiry as a useful addition to existing psychological treatments.
Tyrer
Peter
P
Department of Psychological Medicine, Imperial College, London, UK. p.tyrer@imperial.ac.uk
Sensky
Tom
T
Mitchard
Sarah
S
D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005196:Family Therapy; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D009788:Occupational Therapy; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D012917:Social Adjustment; D012925:Social Conformity; D012949:Social Work, Psychiatric; D012960:Socioenvironmental Therapy; D016896:Treatment Outcome