By Joan E. Shapiro, LCSW, BCD
|Case Study #1 – Deirdre|
|Case Study #2 – Bambi|
Treatment of intense, challenging people with Borderline Personality Disorder, (BPS) often occurs in long term therapies. The main feature of borderline personality disorder (BPD) is a pervasive pattern of instability in interpersonal relationships, self-image and emotions. People with borderline personality disorder are also usually very impulsive.
The client who needs help now but for only a brief time and does not need emergency care, presents an interesting opportunity for professional treatment. Circumstances that cause difficulty for persons with BPD (for example, an impending separation or a period of unstructured time) can be addressed therapeutically. The use of frequent but finite sessions over two to three weeks for clients in a state of emotional turmoil has proved to be a viable tool, both aiding the client at the moment and sending him/her forward with important information and coping skills for the future.
The clients’ strengths can allow them to use a brief intervention to facilitate a move forward with dignity, meeting concrete goals without dissolution into anxiety, anger, or psychic (consider using psychiatric or psychological) collapse. Sometimes these clients come in for help knowing their potential pitfalls, and dreading their typical course of events. Two cases in point:
Deirdre, 22, was a young woman making a move to another state with her boyfriend in 17 days. She came in reporting intense anxiety, sleeplessness, outburtsts of anger and felt “overwhelmed” with what she had to accomplish in two weeks: graduating college, packing, planning the move, securing a place to live, and caravanning to the location. She had the additional stressor of bearing the thought of leaving her parents whom she perceived as ambivilent. She envisioned “losing it” when she imagined her parents receding visually in the distance.
Deidre previously had acute psychiatric admissions and had been enrolled in special programs for emotionally disturbed children. On evaluation, she appeared bright, charming, competent and confident. She was not currently on medications despite having a history of being prescribed psychiatric drugs of all types. Treatment offered her the opportunity to speak to a neutral supportive party who would not be intimidated by her dramatic history, or her apparent push towards independence. How was she to achieve her goal with her deep seated capacity for panic with growth and change? Borrowing from Dialectical Behavior Therapy’s concept of “Skills Training,”, the client learned a relaxation technique which empowered her to cope with her “high idle”. She further enjoyed a meditation technique borrowed from Zen Buddhism which dealt with her thoughts, symptoms, and impulses.
Introduction to these techniques may not be enough to use the techniques well and proficiently, but it established that she had an affinity toward using them A motivated client is essential, and she may do well to educate herself further about these techniques by enrolling in a general course, using an instructional tape, or studying privately.
Case 2: Bambi, a college student facing a month’s vacation is very depressed, unfocused, and overwhelmed. She is unable to mobilize herself toward anything productive and feels unable to pass classes next semester despite her 3.9 average. She is spending each day home in her pajamas..She harbors bitter resentment towards her depressed mother and alcoholic father for not giving her a “foot up” in life and has deep frustrated longings for their support.. Testing the therapist’s interest and limits, but at the same time, understanding that she needed to immediately replace the routine of school and structure her time off, she provided for herself an almost immediate clearing of her negative mental state. In doing so, she boosted her feeling of hope for the future. Sometimes simply the experience of “rising above the ashes” can be a corrective and helpful experience in the futures of clients with such obstacles. [I do not understand how this person is BPD].
Persons with Borderline Personality Disorder are hungry for structure, and the therapist’s interest in and mention of this is often all that is needed to mobilize a client. Needy of a steady, approving parental figure in a therapist, these clients will quickly incorporate the therapist into their mental structure, using the thought of the therapist to endure their frightening feelings. These clients feel proud to report their successes while sustaining their poise, and are able to use therapy to explore emotions, and avoid acting out against their interests, setting sail toward success of goals they have undertaken.
Marsha Linehan’s Dialectical Behavior Therapy and its’ techniques have proven to be useful generally in the psychotherapy of clients with BPD who suffer from unbearable affects and the difficulties with accompanying impulses. Both these clients were taught relaxation/meditation techniques which focus on breathing and progressive muscle relaxation. Clients with BPD who accept this are often grateful to have some effective tool to use for self control. Other methods for self soothing can be explored and elicited with the client’s help.
Clinically trained social workers can help persons with Borderline Personality Disorder lead fuller, more productive lives. These therapists, trained in Dialectical Behavior Therapy are very helpful in its treatment of the most helplessly self destructive clients who perhaps have not been aided by other more conventional treatments.