Paper I wrote for Abnormal Psych class few years ago on BPD

 

Published by the American Psychiatric Associat...
Published by the American Psychiatric Association, the DSM-IV-TR provides a common language and standard criteria for the classification of mental disorders. (Photo credit: Wikipedia)

 

Paper on Borderline Personality Disorder I wrote for Abnormal Psych class
Disorder Paper: Borderline Personality Disorder
Borderline personality disorder is a complicated disorder characterized by black and white thinking also known as all or nothing thinking. Most borderlines are manipulative and insecure. They have low self-esteem and nearly no self-confidence. They have not learned effective coping mechanisms and are unable to distinguish between themselves and the world that they grew up in. Most borderlines have issues with boundaries and limits. They do not have their own and have a hard time allowing others to have boundaries. They tend to be impulsive in their actions and unable to think before acting for the most part. The diagnostic statistical manual for mental health disorders states,
Diagnostic criteria for 301.83 Borderline Personality Disorder- A pervasive pattern of instability of interpersonal relationships, self image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of self
Impulsivity in atleast two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
Transient, stress-related paranoid ideation or severe dissociative symptoms. (DSM IV-TR)
Dr. Corelli describes Borderline Personality Disorder as, “There is a deep-seated feeling that one is flawed, defective, damaged, or bad in some way, with a tendency to go to extremes in thinking, feeling, or behavior. Under extreme stress or in severe cases there can be brief psychotic episodes with loss of contact with reality or bizarre behavior or symptoms” (Corelli). “Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone” (NIMH 2008). “A person with this disorder can often be bright and intelligent, and appear warm, friendly, and competent. They sometimes can maintain this appearance for a number of years until their defense structure crumbles, usually around a stressful situation like the breakup of a romantic relationship or the death of a parent” (Corelli). Symptoms appear to minimize as the Borderline ages. This may be due to life experience as they grow; they seem to manage their symptoms better. Their lives seem to settle down and become more stable. They commence to be able to function and manage better as they age.
There is an influential connection between child abuse, neglect, and Borderline Personality Disorder. More women than men are identified as having BPD. According to an article, “Borderline personality disorder (BPD) is a common and severe condition with substantial morbidity and mortality. BPD has a point prevalence of 1% to 2% in the general population, but the rate climbs to 10% to 20% in the mental health treatment settings. BPD is manifested by a wide array of symptoms and is associated with significant functional impairment and mortality rates approaching 10% in long-range naturalistic studies” (Gregory, Remen 2008). The DSM IV-TR states, “Physical and sexual abuse, neglect, hostile conflict, and early parental loss or separation are more common in the child-hood histories of those with Borderline Personality Disorder” (DSM IV-TR, pg.708). It also states, Borderline Personality Disorder is about five times more common among first-degree biological relatives of those with the disorder than in the general population” (DSM IV-TR, pg.709). There is some evidence of biological connection although studies have not shown clear evidence of what genetic links there are in BPD.
During recent years, there have been many studies done and treatment for BPD is more widespread now than a decade ago. There is still a stigma against people diagnosed with BPD in the world and the mental health system itself. One article advises, “Individuals with Borderline Personality Disorder are often unfairly discriminated against within the broad range of mental health professionals because they are seen as ‘trouble-makers'” While they may indeed need more care than many other patients, their behavior is caused by their disorder” (Levin 2001). It also states, “Many professionals are turned-off by working with people with this disorder, because it draws many negative feelings from the clinician” (Levin 2001). An article on the web says, “People with borderline personality disorder are among the most difficult to treat with psychotherapy, in part because their relationship with their therapist may become as intense and unstable as their other personal relationships” (Personality Disorders). Treatment providers need to set and stick with clear limits. They need to be able to provide support to the borderline but not allow the borderlines manipulative behavior to interfere in the treatment they are providing.
Over the past decade or so there have been many treatments suggested for treating borderlines but not many have shown to be effective in the long-term treatment of Borderline Personality Disorder. An article reads, “Treatment includes psychotherapy which allows the patient to talk about both present difficulties and past experiences in the presence of an empathetic, accepting, and non-judgemental therapist. The therapy needs to be structured, consistent and regular, with the patient encouraged to talk about his or her feelings rather than to discharge them in his or her usual self-defeating ways” (Corelli). The most effective treatment that has shown to be effective is DBT. Dialectical behavioral therapy first introduced by Marsha Linehan has shown to be the most effective in helping the borderline learn to live their life to the fullest they are capable of. An article states, “Therapy should help to alleviate psychotic or mood-disturbance symptoms and generally integrate the whole personality. With this increased awareness and capacity for self-observation and introspection, it is hoped the patient will be able to change the rigid patterns tragically set earlier in life and prevent the pattern from repeating itself in the next generational cycle” (Corelli). Treatment of the borderline client and its effectiveness depends on the investment of the client. They borderline needs to want to change to effectively benefit from any treatment that is provided including but not limited to; DBT, psychotherapy, medications, or other methods that has not been mentioned but may help. Borderline Personality Disorder needs to be studied more to find more beneficial treatments.

 

Works Cited:
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
Corelli M.D., Richard J., “Borderline Personality Disorder”, http://www.stanford.edu. Retrieved October 17, 2008. http://www.stanford.edu/~corelli/borderline.html.
NIMH., “Borderline Personality Disorder”. http://www.nimh.nih.gov. Retrieved October 15, 2008. Last reviewed: June 26, 2008. http://www.nimh.nih.gov/health/publications/borderline-personality-disorder.shtml.
“Personality Disorders”, Microsoft Encarta Online Encyclopedia 2008. Retrieved October 15, 2008. Http://encarta.msn.com. © 1997-2008 Microsoft Corporation. All Rights Reserved.

 

 

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15 August, 2011 00:55

 

COMMITMENTS :  Cutting the Cord :  Saying goodbye to your therapist can elicit bad feelings–unless it’s handled right. Then the parting can be a chance for growth.

December 04, 1995|LIBBY SLATE | SPECIAL TO THE TIMES
You’ve been in psychotherapyfor a while and feel your therapist just isn’t meeting your needs anymore, so you decide it’s time for a change. Or perhaps it is your therapist who is moving on–leaving town, going on maternity leave, retiring because of age or illness.Whatever the reason for bidding adieu, when the two of you part company, you’re not just breaking off with a mental-health professional. Therapy involves transference, in which you transfer feelings about important figures in your life onto the therapist. So you’re also saying sayonara to your mother, your father, significant others past and present, best friend, maybe a sibling or two–so many people it’s a wonder you can all fit into one office.

That period of wrapping up therapy and saying goodbye is known as “termination,” a word that evokes images of being fired from a job or being stalked by Arnold Schwarzenegger. But mental-health experts consider termination a crucial stage in therapy.

If handled properly, it provides an opportunity to re-examine the issues that led the client to seek help in the first place, to evaluate the therapy itself and to deal with feelings that might bubble up in the face of bidding farewell.

A so-called natural termination, in which the two of you agree to end treatment because your goals have been met, is difficult enough. Who, after all, likes to say goodbye, especially to someone who has helped you so profoundly and so intimately? But a premature termination, where a dissatisfied client leaves without much notice or a therapist departs before the patient is ready, can be downright traumatic.

“It’s always best if people can have time to pay attention to the process of saying goodbye,” says Carl Shubs, a licensed clinical psychologist in private practice in Beverly Hills. “If people leave too abruptly, it interferes with the process–they’re not able to deal with the sadness or anger, the mourning that occurs.”

Adds Sylvia Martin, a licensed marriage, family and child therapist in private practice in Sherman Oaks: “Termination is a time when people start to deal with all their losses. It can trigger feelings about old issues, or issues about the relationship between the therapist and client.

“If there is an old loss they have not grieved, they will tap in and experience the same feelings,” she says. “Maybe they had a feeling of abandonment when they were young and did not understand it. Or maybe they have not had the luxury before now of dealing with a loss–for example, going through a divorce with two kids.”

*

If it is the patient who says so long, a good therapist will try to determine if he or she wants out because the topics being discussed are becoming too painful. In those cases, the therapist will encourage the patient to remain, so as to work through the discomfort and resolve those issues.

Many times, though, the client is willing to slog through the hard stuff, but feels this particular therapist is less than able. Such was the case last year for Laura, 41, who works in the travel industry in Orange County and sought counseling for marital problems.

“I was therapy illiterate,” she recalls. “I had no basis for comparison. But I never felt I was getting help. I would drive home and think, ‘Why did I just go there?’ I didn’t expect a magic cure, but I was just begging my therapist, ‘Give me some tools to help me.’

“All she said was, I had to divorce my husband, which I wasn’t ready to do. I felt her attitude was, ‘You won’t take my advice, so I don’t know what to tell you.’ ”

Laura–who is still married and on better terms with her husband–found another therapist to her liking. But she stuck with her first counselor longer than she preferred to because, she says, “The last thing I wanted was to look for someone new to spill my guts to, to start over again.”

Indeed, for some people, leaving the current therapist is the easy part; it’s finding a new one that poses problems. Says Studio City writer Catherine Johnson, author of the book “When to Say Goodbye to Your Therapist” (Simon and Schuster, 1988), “Finding a new therapist is not like finding a new dentist. It’s extremely difficult to find a match.

“It’s a bit like finding a lover, or best friend, or a parent. You don’t just go out and find a new best friend. You have to find a real emotional fit, on top of basic competence.”

Lisa Moore, 34, a West Los Angeles advertising account executive, discovered that last year when she left the marriage and family counselor she had been seeing for 15 months because she thought the therapist had crossed the professional line and was becoming too friendly. After six weeks with a new therapist recommended by her physician, she decided to return to her former counselor.

http://articles.latimes.com/1995-12-04/news/ls-10124_1_bad-feelings

visit my website: http://www.lkg4btrlife.webs.com

 

14 August, 2011 23:20

When is it time to say
goodbye to a therapist?

By Alexia
Elejalde-Ruiz

Chicago Tribune

Posted: 03/29/2011 01:00:00 AM MDT

Maybe you don’t like your therapist. Maybe you do, but you’ve resolved the
issues that drove you to seek counseling in the first place. Or maybe those
issues remain unresolved, with few signs of progress. Maybe your sessions feel
as if they’ve morphed into very expensive chats with a friend.

For myriad reasons, people come to a point when they wonder if they should
break up with their therapist. And “break up” is the right term for it, because
quitting therapy can spur emotions as painful and complicated as ending a
romantic relationship.

How do you know if you’re ready to stop therapy? And how should you go about
it? First, any therapy that is abusive or destructive should be stopped
immediately, said Dr. Kenneth Settel, clinical instructor in psychiatry at
Harvard Medical School. Examples of abusive therapists are those who are
disrespectful or insensitive to certain issues; those who violate boundaries;
those who reveal too much about their own problems; and those who insist on
focusing on areas the patient didn’t come in for.

But assuming you’re not dealing with that, patients should approach ending
therapy as a chance to grow, Settel said. Rather than cut and run or avoid the
topic altogether — tempting routes for the confrontation-avoidant — it’s
important that patients, well, talk to their therapist about it.

In therapy, the relationship between the patient and the therapist is a
vehicle for understanding the patient’s issues, Settel said. So the way you end
therapy can be a way of examining how you say goodbye to people, and the
feelings involved in leaving and loss.

Ask yourself why you want to move on. When did you start feeling that the
therapy was no longer helpful or productive? What happened that made it
different? Was there a change in you, in the topics being discussed, in the
therapist? Confronting that tension can be a turning point because it forces you
to work through obstacles, Settel said.

“Ending therapy can be very therapeutic,” Settel said.

Though the patient-therapist relationship can have a weird power dynamic —
you’re paying, but the therapist is the expert and knows your every demon —
patients should feel they have control of the process, said Lynn Bufka, a
psychologist and head of the department of practice, research and policy at the
American Psychological Association. Patients should feel empowered to ask
questions, steer the sessions to focus on particular issues and let the
therapist know what’s not working.

The tricky part is making sure you’re not leaving therapy just because it’s
unpleasant or difficult, which oftentimes it has to be, Bufka said. More than
make you feel better, therapy is supposed to help you understand yourself
better.

On the flip side, therapy shouldn’t be some indefinite appointment you keep
as part of your routine. There should be regular discussions about what you’re
trying to accomplish and whether you’re meeting those goals.

“I hope that I’m going to work myself out of a job,” Bufka said.

There is such a thing as staying in therapy for too long. One warning sign is
if a patient has to run all decisions by his or her therapist, which can signal
dependency, Bufka said. Another concern is if the therapist relationship is
taking the place of building other relationships.

Another downside of staying in therapy for too long is that you don’t have
the opportunity to practice the skills you’re developing independently, Settel
said. If the therapy was aiming to help you build internal skills of
self-observation, stopping therapy can encourage growth because it forces you to
internalize the process.

Read more: When is it
time to say goodbye to a therapist? – The Denver Post
http://www.denverpost.com/lifestyles/ci_17720234#ixzz1YuUEWgne

Read The Denver Post’s Terms of Use of its content:
http://www.denverpost.com/termsofuse

http://www.denverpost.com/lifestyles/ci_17720234

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14 August, 2011 23:16

 

How to Figure Out When Therapy Is Over

Published: October 30, 2007

If you think it’s hard to end a relationship with a lover or spouse, try breaking up with your psychotherapist.

A writer friend of mine recently tried and found it surprisingly difficult. Several months after landing a book contract, she realized she was in trouble.

“I was completely paralyzed and couldn’t write,” she said, as I recall. “I had to do something right away, so I decided to get myself into psychotherapy.”

What began with a simple case of writer’s block  turned into seven years of intensive therapy.

Over all, she found the therapy very helpful. She finished a second novel and felt that her relationship with her husband was stronger. When she broached the topic of ending treatment, her therapist strongly resisted, which upset the patient. “Why do I need therapy,” she wanted to know, “if I’m feeling good?”

Millions of Americans are in psychotherapy, and my friend’s experience brings up two related, perplexing questions. How do you know when you are healthy enough to say goodbye to your therapist? And how should a therapist handle it?

With rare exceptions, the ultimate aim of all good psychotherapists is, well, to make themselves obsolete. After all, whatever drove you to therapy in the first place — depression, anxiety, relationship problems, you name it — the common goal of treatment is to feel and function better independent of your therapist.

To put it bluntly, good therapy is supposed to come to an end.

But when? And how is the patient to know? Is the criterion for termination “cure” or is it just feeling well enough to be able to call it a day and live with the inevitable limitations and problems we all have?

The term “cure,” I think, is illusory — even undesirable — because there will always be problems to repair. Having no problems is an unrealistic goal.  It’s more important for patients to be able to deal with their problems and to handle adversity when it inevitably arises.

Still, even when patients feel that they have accomplished something important in therapy and feel “good enough,” it is not always easy to say goodbye to a therapist.

Not long ago, I evaluated a successful lawyer who had been in psychotherapy for nine years. He had entered therapy, he told me, because he lacked a sense of direction and had no intimate relationships. But for six or seven years, he had felt that he and his therapist were just wasting their time. Therapy had become a routine, like going to the gym.

“It’s not that anything bad has happened,” he said. “It’s that nothing is happening.”

This was no longer psychotherapy, but an expensive form of chatting. So why did he stay with it? In part, I think, because therapy is essentially an unequal relationship. Patients tend to be dependent on their therapists. Even if the therapy is problematic or unsatisfying, that might be preferable to giving it up altogether or starting all over again with an unknown therapist.

Beyond that, patients often become stuck in therapy for the very reason that they started it. For example, a dependent patient cannot leave his therapist; a masochistic patient suffers silently in treatment with a withholding therapist; a narcissistic patient eager to be liked fears challenging his therapist, and so on.

Of course, you may ask why therapists in such cases do not call a timeout and question whether the treatment is stalled or isn’t working. I can think of several reasons.

To start with, therapists are generally an enthusiastic bunch who can always identify new issues for you to work on. Then, of course, there is an unspoken motive: therapists have an inherent financial interest in keeping their patients in treatment.

And therapists have unmet emotional needs just like everyone else, which certain patients satisfy. Therapists may find some patients so interesting, exciting or fun that they have a hard time letting go of them.

So the best way to answer the question, “Am I done with therapy?” is to confront it head on. Periodically take stock of your progress and ask your therapist for direct feedback.

How close are you to reaching your goals? How much better do you feel? Are your relationships and work more satisfying? You can even ask close friends or your partner whether they see any change.

If you think you are better and are contemplating ending treatment but the therapist disagrees, it is time for an independent consultation. Indeed, after a consultation, my writer friend terminated her therapy and has no regrets about it.

The lawyer finally mustered the courage to tell his therapist that although he enjoyed talking with her, he really felt that the time had come to stop. To his surprise, she agreed.

If, unlike those two,  you still cannot decide to stay or leave, consider an experiment. Take a break from therapy for a few months and see what life is like without it.

That way, you’ll have a chance to gauge the effects of therapy without actually being in it (and paying for it). Remember, you can always go back.

Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.

http://www.nytimes.com/2007/10/30/health/views/30beha.html

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Farewell By: Matthew Groff

 

Farewell

Open our eyes and the world can seem a scary place. Open our minds and the choices can overwhelm. Open our hearts, and we may feel a need to lessen the pain. Look to our souls to choose a path. Remember the joy, remember the discovery, Remember all we h…ave learned, Remember the friendship, remember the love… With feeling. Remember the pain, for what it taught us About ourselves, about our world. But, remember with mindfulness, And let the hurt go. In the darkest and coldest of nights, Our fearful or angery expectations will not serve us. But our dreams of a brighter warmer day Will illuminate a path to that dawn. Hope heals, hope sustains, Hope can warm cold hearts and open closed minds. To forgive ourselves, to forgive others, To dream of a better world that yet may be, This is love. To act on love, To be willing to strive and sacrifice For the growth and healing, Of ourselves and others, Is to be responsibly human. With such humans I have fought alongside for what I believes is just and fair, With such humans, I have wept, With such humans I have laughed, With such humans I have even vented and stormed. I have seen more than my fair share of bright warm days. Now, not by choice I must go. Without expectation that I will see days as bright or warm, Or coworkers as responsibly human. But with hope that I may be able to appreciate, How bright those tomorrows may be, And how responsibly human those future coworkers may be, Or, may yet become. When we look to the future, We create paths of energy That draws those futures to us. Always dream of brighter days… Especially in the dark cold nights. See More

By: Matthew Groff

 

Marsha M. Linehan works with seriously suicidal people, having faced the same struggles when she was younger.

 

Expert on Mental Illness Reveals Her Own Fight

By BENEDICT CAREY

Published: June 23, 2011

Marsha M. Linehan works with seriously suicidal people, having faced the same struggles when she was younger.

http://www.nytimes.com/2011/06/23/health/23lives.html

 

The Cognitive Behavioral Therapy … – Google Books

 

English: Approximate Prevalence Distribution o...
English: Approximate Prevalence Distribution of the Subtypes of ADHD as cited by Cognitive-Behavioral Therapy for Adult ADHD. New York, NY: Routledge. 2008. (Photo credit: Wikipedia)

 

The Cognitive Behavioral Therapy … – Google Books

 

 

Applying Learning Principles to Thought: Cognitive Restructuring – Psychological Self-Tools – Online Self-Help Book

 

English: Arnold's appraisal theory of emotion
English: Arnold’s appraisal theory of emotion (Photo credit: Wikipedia)

 

Applying Learning Principles to Thought: Cognitive Restructuring – Psychological Self-Tools – Online Self-Help Book

 

Cognitive Restructuring (sometimes known as “reframing”) is essentially the core technique from cognitive behavioral therapy, a highly regarded, scientifically validated psychotherapy format. The technique is designed to help you alter your habitual appraisal habits so that they can become less biased in nature and you less moody. You alter your appraisal habits by becoming aware of them as they occur, and then criticizing and critiquing them. Usually there is no logical or rational basis for your appraisal bias. When you really examine your judgments carefully, looking for evidence to support them, you find that there is none. You are then in a position to form a new, more accurate appraisal.

 

Appraisal habits cannot be manipulated directly, but the thoughts that carry them can be. The first task in cognitive restructuring is thus self-monitoring; learning to become more aware of your thought behaviors. Habitual appraisal habits are not conscious things, and neither are the thoughts that carry them. In addition to the thoughts you are conscious of having, there are also all manner of unconscious automatic thoughts which flit through your mind without you noticing. Automatic thoughts are not inherently unconscious; they are just so common that you’ve habituated to them and no longer notice them.

 

You become more conscious of your automatic thoughts by self-monitoring. We don’t want to count thoughts, however, so much as we want to record them. A good way to do this is to write down all the thoughts that occur to you shortly after some event has occurred that causes you to feel bad.

 

Automatic thoughts are often situation specific instances of more core fixed beliefs about yourself and the world. While automatic thoughts reflects your reaction to a given event, core beliefs describes your general expectations and identity. For example, if you have recently done poorly on a test, your automatic thought will probably reflect your situation, “I’m so embarrassed! I should have done better!” , while your core belief might reflect a deeper fear: “I’m a stupid person!” Core beliefs influence appraisals, and thus are a major source of bias. They are not always obvious or conscious. The way to identify them is to examine multiple instances of your automatic thoughts over time for the repetitive themes that underlie them. You will likely be able to distill some of your core beliefs by examining your self-monitoring thought records, and by asking yourself the question, “Why am I reacting this way?”.

 

Writing down your automatic thoughts and core beliefs makes it easier for you to get a handle on them; to view them from an outsider’s perspective rather than your own. When you actually get to look at what you are thinking and believing, you may find that your thoughts and beliefs are inaccurate, incorrect or irrational, and that with a little work you can correct them so that they better reflect “reality”; the shared social consensus.

 

 

Cognitive Restructuring – Definition of Cognitive Restructuring

 

Cognitive Restructuring – Definition of Cognitive Restructuring

Definition: A cognitive-behavioral therapy technique used to identify and correct negative thinking patterns. The technique involves altering negative automatic thoughts that occur in anxiety-provoking situations (such as “They think I’m boring”) by replacing them with more rational beliefs (such as “I can’t read other people’s minds; they are probably just tired”). As thoughts are challenged and disputed, their ability to elicit anxiety is weakened.