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.
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.
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.
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 neuroscience, 10(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 disorder. https://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.