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Respond  by providing one alternative therapeutic approach. Explain  why you suggest this alternative and support your suggestion with  evidence-based literature and/or your own experiences with clients.

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Therapy for Clients with Personality Disorders

According  to the American Psychiatric Association (2013b) there are six types of  personality disorders: borderline personality disorder,  obsessive-compulsive personality disorder, avoidant personality  disorder, schizotypal personality disorder, antisocial personality  disorder, and narcissistic personality disorder. The DSM-5 has them  listed under section III in Specific Personality Disorders  (American Psychiatric Association, 2013a, p 763). All patients should be  assessed for “personality functioning” and traits because personality  disorders can affect other mental disorders (American Psychiatric  Association, 2013a, p 763). Diagnosing a patient with a personality  disorder can be difficult because they usually have traits that  “overlap” with other personality disorders (American Psychiatric  Association, 2013a, p 761). The purpose of this post is to consider  therapeutic approaches to use for clients with a personality disorder.  This discussion will describe borderline personality disorder (BPD),  explain a therapeutic approach I might use to treat a client with BPD,  and discuss how I would tell the patient the diagnosis without damaging  our therapeutic relationship.

I often hear that patient has cluster B personality traits. That can include “antisocial  personality disorder, borderline personality disorder, histrionic  personality disorder, and narcissistic personality disorder” (Mayo Clinic, 2016). For this assignment, I decided to focus on BPD because I see it more often.

According  to the Mayo Clinic (2019), BPD causes and risk factors may stem from  genetics, brain abnormalities, and/ or a stressful childhood. Persons  with BPD have a maladaptive schema of “abandonment/instability” that  cause them to have negative beliefs about themselves and situations  (Wheeler, 2014, p 326). Their fear abandonment and issues with trusting  others, causes them to sabotage relationships (Wheeler, 2014, p 243).  This also makes it difficult when attempting to establish a therapeutic  relationship (Wheeler, 2014, p 243).

Another  concern is persons with BPD have problems with intense emotions and  self-regulation (NAMI, 2017). They are prone no injurious behavior or  self-harm when stressed or feeling rejected (Howe, 2013). According to  Dr. Edmund Howe (2013), “on average”, these patients will “attempt  suicide 3.3 times” in their life and as many as 10% complete suicide.

Therapeutic Approach

Psychodynamic psychotherapy and dialectical behavior therapy (DBT) are  the therapies of choice for BPD (Wheeler, 2014, p 242). DBT being the  “gold standard” for BPD, is the approach I would use (Greenstein, 2017).  For BPD patients, DBT is used to teach “behavioral” and coping skills  to deal with symptoms (Greenstein, 2017). Therapy teaches mindfulness,  distress tolerance, interpersonal effectiveness, and emotion regulation  (Greenstein, 2017). Each skill set is in its own module and it takes a  “year to go through all four modules” (Greenstein, 2017). One study  boasts that DBT has a 77% success rate (Greenstein, 2017).

Telling the Patient

There was a time, practitioners were reluctant to tell a patient they  have BPD due to fears of patient reactions (Howe, 2013). Stigmas against  BPD because it was believed to be a condition somewhere between  psychosis and neurosis and lacked any real treatment options, making it  more difficult to discuss (Howe, 2013). The current belief is that being  open with the patient and explaining the diagnosis can benefit  treatment and help the patient process what they are going through  (Howe, 2013).

I would tell the patient their diagnosis and over the diagnosis  criteria with them. Doing this allows the patient to relate the criteria  with their symptoms (Howe, 2013). It may also give them peace of mind  that they are not to blame and being diagnosed means they can now start  treatment and hopefully get better.

References:

American Psychiatric Association. (2013a). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

American Psychiatric Association. (2013b). Personality Disorders. file:///C:/Users/1Insignia5/Downloads/APA_DSM-5-Personality-Disorder.pdf

Greenstein, L. (2017). Treating Borderline Personality Disorder. NAMI. https://www.nami.org/Blogs/NAMI-Blog/June-2017/Treating-Borderline-Personality-Disorder

Howe  E. (2013). Five ethical and clinical challenges psychiatrists may face  when treating patients with borderline personality disorder who are or  may become suicidal. Innovations in clinical neuroscience10(1), 14–19.

Mayo Clinic. (2016). Personality disorders.  https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463

Mayo Clinic. (2019). Borderline personality disorderhttps://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237

NAMI. (2017). Borderline Personality Disorder. https://nami.org/About-Mental-Illness/Mental-Health-Conditions/Borderline-Personality-Disorder

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). Springer Publishing Company.