Treatment of Borderline Personality Disorder

Respond to your colleagues 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.

RUFINA EWANE 

Week 10 discussion. Initial  

Group therapy may be helpful tool for treatment of mental health issues in children and adolescents, because it often provides a structured and safe environment for clients to explore their thoughts, feelings, and behaviors. There are several types of psychotherapy that involve different approaches, techniques, and interventions. Determining the right approach for the group entails a careful assessment of client’s needs.

DSM5 diagnosis for the client

The DSM5 diagnosis for this client is borderline personality disorder (BPD). Borderline personality disorder is a serious mental health condition that may cause difficulties in managing emotions effectively. Borderline personality disorder (BPD) is a psychiatric condition that is characterized by emotional instability, impulsivity, risk-taking behavior, fear of abandonment by significant others, depressed mood or feelings of emptiness, self-injury or suicidal intentions, and occasional paranoid ideation and dissociative states (American Psychiatric Association, 2013).. People who live with BPD can experience rapid changes in mood that last from a few hours to a few days that may lead to substantial distress and disruption in functioning. They may also experience issues of identity, impulsivity, strong pattern of instability in a person’s relationships, self-image (American Psychiatric Association. (2013). This client presents with some key features of BPD such as low self-esteem, self-harm, impulsivity, fear of abandonment, feelings of emptiness and difficulties managing his emotions.

Group therapeutic approaches I might use with this client and expected outcome

The therapeutic group approaches that may be used for this client is dialectical behavior therapy (DBT) and mentalization-based treatment (MBT). I chose this approach because it has proven effective in clinical trials. In a review by Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A., & Unruh, B. T. (2017), it was noted that DBT showed higher reduction in suicidal behavior and self-injury, in inpatient hospitalization than treatment by other experts in the community. Also, patients with borderline personality disorder may be treated best with structured and specifically designed forms of psychotherapy.  Dialectical behavior therapy (DBT) is a structured treatment approach proven to be effective for the treatment of borderline personality disorder (May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy is based on cognitive-behavioral principles and it is designed to target the emotion dysregulation (mood instability) and to reduce impulsive behavior in BPD. Dialectical behavior therapy aims to address the symptoms of BPD by replacing maladaptive behaviors with healthier coping skills, such as mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. With DBT, patients learn behavioral skills that target common symptoms of BPD, including an unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity. Therefore, the expected outcome for this client would be for the client to experience significant reductions in BPD symptoms such as self-injurious behavior, improve interpersonal relation, promote development in mentalization and improvement in overall functioning after active participation and completion of the therapy

Another therapeutic approach that can be used is mentalization-based treatment (MBT). According to Bateman, A., & Fonagy, P. (2010), patients with BPD show reduced capacities to mentalize, which leads to problems with emotional regulation and difficulties in managing impulsivity, especially in the context of interpersonal interactions. Mentalization based treatment (MBT) is a time-limited treatment which structures interventions that promote the further development of mentalizing (Bateman, A., & Fonagy, P. (2010). The focus in treatment of BPD needs is to stabilize the sense of self and help the patient maintain an optimal level of arousal in the context of a well-managed, i.e. not too intense and yet not too detached, attachment relationship between patient and therapist (Bateman, A., & Fonagy, P. (2010). In both DBT and MBT, patients are taught to observe their emotions, to learn how to tolerate them, and to manage them in more adaptive ways. According to Bateman, A., & Fonagy, P. (2010), a patient randomized to MBT showed a steeper decline of both self-reported and clinically significant problems, including suicide attempts and hospitalization

Legal and ethical implications of counseling children and adolescent clients with psychiatric disorders

Treating adolescents in psychotherapy may pose a number of unique ethical challenges. Given the importance of respecting adolescent clients' privacy and maintaining their confidentiality, is one ethical concern for counseling children and adolescents with psychiatric disorders is clients' privacy and confidentiality. Determining and discussing the limitations of confidentiality with client is very relevant. For an adolescent, disclosure of mental health disorder may contribute to negative stigma (Rodriguez, M. A., Fang, C. M., Gao, J., Robins, C., & Rosenthal, M. Z., 2016). Also, disclosures of information about an adolescent's mental health disorder might result in the client having to deal with inquisitive peers, who may feel uncomfortable around him or subject him to ridicule. Child and adolescent psychiatric nurse practitioner counseling clients should inform patients and their parents or guardians about confidentiality and any limitations to confidentiality at the start of each therapeutic relationship. They need to be informed that threats of harm to self or others will not be kept confidential. Another issue that may arise adolescent competence to consent to treatment and to the choice of treatment goals (Rodriguez, M. A., Fang, C. M., Gao, J., Robins, C., & Rosenthal, M. Z.,2016). Because adolescents who enter treatment have not yet attained the age of majority obtaining consent for treatment may be challenging for the counselor as the therapist and would need to take direction from adult authority figures and at same time seek the adolescent consent.

Reference

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

Bateman, A., & Fonagy, P. (2010). Mentalization based treatment for borderline personality disorder. World psychiatry : official journal of the World Psychiatric Association (WPA), 9(1), 11–15. https://doi.org/10.1002/j.2051-5545.2010.tb00255.x

Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A., & Unruh, B. T. (2017). What Works in the Treatment of Borderline Personality Disorder. Current behavioral neuroscience reports, 4(1), 21–30. https://doi.org/10.1007/s40473-017-0103-z

Rodriguez, M. A., Fang, C. M., Gao, J., Robins, C., & Rosenthal, M. Z. (2016). Perceptions of the Limitations of Confidentiality Among Chinese Mental Health Practitioners, Adolescents and Their Parents. Ethics & Behavior, 26(4), 344–356. https://doi-org.ezp.waldenulibrary.org/10.1080/10508422.2015.1038748

May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. The mental health clinician, 6(2), 62–67. https://doi.org/10.9740/mhc.2016.03.62