Borderline personality disorder: a clinical guide
Saved in:
| Main Author: | |
|---|---|
| Format: | Book |
| Language: | English |
| Published: |
Washington, DC [u.a.]
American Psychiatric Publ.
2001
|
| Edition: | 1. ed. |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XXII, 329 S. graph. Darst. |
| ISBN: | 1585620165 |
Staff View
MARC
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| 245 | 1 | 0 | |a Borderline personality disorder |b a clinical guide |c John G. Gunderson |
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| 264 | 1 | |a Washington, DC [u.a.] |b American Psychiatric Publ. |c 2001 | |
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Record in the Search Index
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|---|---|
| adam_text | Contents
About the Author xm
Preface xv
Acknowledgments xvn
Introduction xix
1 The Borderline Diagnosis 1
Origins of the Diagnosis 1
Sidebar 1 1: Where Were the Borderlines Before the Diagnosis? 2
Shifts in the Borderline Construct: From Organization to Syndrome to Disorder 5
An Explication of the DSM IV Criteria 9
Sidebar 1 2: Borderline Personality as an latrogenic Disorder 12
Sidebar 1 3: The Subjective Experience of Being Borderline 13
A Clinical Synthesis: Intolerance of Aloneness 15
Sidebar 1 4: British Developmentalists—From Winnicott to Bowlby to Fonagy 16
Misuses of the Borderline Diagnosis 19
Sidebar 1 5: Wisdom Is Never Calling a Patient Borderline 21
The Behavioral Specialty: Self Injurious Behavior 21
Sidebar 1 6: Cutting: Social Contagion or Serious Disorder 23
How to Explain the Diagnosis 24
Summary 25
References 25
2 Differential Diagnosis: Overlaps, Subtleties, and Treatment Implications 35
Overall Function 35
The Changing Construct: From Schizophrenia to Depression to Posttraumatic Stress
Disorder 36
Comorbidity and Differential Diagnosis 38
BPD and Depression 39
BPD and Bipolar II Disorder/Cyclothymic Personality 41
BPD and PTSD 44
BPD and Eating Disorders 46
8PD and Substance Abuse 48
BPD and Somatoform/Somatization Disorders SO
BPD and Narcissistic Personality Disorder 50
Sidebar 2 1: Is Martha Stewart Borderline? I Think Not. 51
BPD and Antisocial Personality Disorder (ASPD) 54
Summary 57
References 57
3 Overview of Treatment 63
Historical Overview 63
Generic Therapeutic Processes and the Functions They Serve 65
Containment 67
Support 67
Structure 68
Involvement 68
Validation 69
Multiple Modalities and Step Down Services: An Overview 69
Sociotherapies 70
Generic Sequence of Change 70
Sequence of Expectable Changes for BPD 72
Sidebar 3 1: Can Consumers Judge Progress? 72
Changes Within Four Spheres 75
Affects 75
Behaviors: Impulse/Action Pattern 76
Social Function: Impairment 76
Relationship With Treaters 77
General Principles That Guide the
Initial Structuring of Treatment 78
Diagnosis 78
Comorbidity 78
Primary Clinician 78
Short Term Goals 78
Least Restrictive Safe Treatment Setting 79
Types and Sequence of Therapeutic Alliance 79
Sidebar 3 2: Myths About Alliance With Borderline Patients 80
Countertransference 80
Summary 81
References 82
4 Case Management: The Primary Clinician 85
Qualifications 86
Responsibilities 86
Liability Issues 88
Sidebar 4 1: Guidelines to Avoid Liability 89
Relationship Management 89
Managing Safety 91
Assessing Suicidality 91
A Preventive Stance 92
Responding to Feeling Unsafe 92
Sidebar 4 2: Is Contracting for Safety Safe? 93
Responding to Recurrent Suicidality: The Principle of False Submission 97
Implementing Changes 100
Boundaries, Violations, and Setting Limits 101
Splits, Splitting, and the Principle of Split Treatment 102
Sidebar 4 3: How Psychotherapeutic Technique Relates to Level of Care 104
Summary 105
References 105
5 Levels of Care: Indications, Structure, Staffing 107
Selecting or Changing a Level of Care 108
Level IV: Hospital Treatment Makes Therapy Possible 110
Sidebar 5 1: Is Long Term Hospitalization Desirable for BPD? 110
Goals: Contain Patients for Safety, Assessments, and Treatment Planning 112
Structure 113
Staff 113
Level III: Residential/Partial Hospital Care Basic Socialization 114
Goals 115
Sidebar 5 2: Vocational Counseling: Should He or She Return to School, Pursue a Career,
or Become a Caregiver? 116
Staff 117
Structure 118
Sidebar 5 3: Empirical Support for a Psychoanalytic Day Hospital 120
Level II: Intensive Outpatient Care Behavioral Change 122
Goals 123
Components 124
Level I: Outpatient Care Interpersonal Growth 126
Summary 127
References 128
6 Pharmacotherapy: Clinical Practices 131
History 131
Overall Role of Medications 132
Sidebar 6 1: Listening to Prozac: Can SSRIs Cure BPD? 133
Getting Started 135
Sidebar 6 2: I Don t Know If It Will Help 135
The Prescribing Psychiatrist s Role 136
With the Borderline Patient 136
As the Primary Clinician (Psychiatrist/Therapist) 136
As the Psychopharmacologist Only (Split Treatment) 138
Sidebar 6 3: Liability Hazards of Split Treatment 138
Symptom Chasing 139
Attitudes, Meanings, and Attributions 140
Transference Countertransference Issues 141
Contraindications/Discontinuance 143
Summary 145
References 146
7 Pharmacotherapy: Selection of Medications 149
Introduction 149
Overview 149
Comorbidity and Differential Diagnostic Considerations 152
Selective Serotonin Reuptake Inhibitors: The Usual Starting Point 153
Behavioral Symptom Resistance to SSRIs 155
Mood Symptom Resistance to SSRIs 155
Cognitive Symptoms 157
Summary 158
References 158
8 Cognitive Behavioral Therapies: Dialectical Behavior Therapy,
Cognitive Therapies, and Psychoeducation 163
Overview 163
Historical Context 164
Clinical Cautions 164
Growth in the Use of Cognitive Behavioral Therapy With BPD 166
Basic Operant Conditioning Applications for All Treatment Settings 166
Dialectical Behavior Therapy (DBT) 168
DBT Theory 168
The Basic DBT Services 169
Empirical Support 173
Sidebar 8 1: DBT s Limitations: Checking the Flood 174
Perspective on DBT 179
Cognitive Therapies 179
Sidebar 8 2: Makes Sense, But Does it Work? Part 1 Preliminary Findings on
Brief Cognitive Therapy 181
Psychoeducation for Patients 182
Summary 184
References 185
9 Family Therapies 189
Introduction 189
History 190
Therapists and Countertransferences 192
Getting Started: Overcoming Resistance 193
Sidebar 9 1: You Can t Talk to My Parents 194
Phase 1: Initial Family Meetings 195
Sidebar 9 2: Families of Married Borderline Patients 196
Problem Identification 196
Psychoeducation 197
Support 198
Sidebar 9 3: Finessing the Guilt Issue 198
Phase 2: Establishing an Alliance 199
Resistance to the Borderline Diagnosis 199
Resistance to Being Involved in Treatment 200
End of Phase 2: Transition From Treatment to Therapy 201
Phase 3: Psychoeducational Family Therapy 201
Single Family Interventions 202
Adaptations for a Multiple Family Group (MFG) 202
Three Stages of Psychoeducational Family Therapies 203
Sidebar 9 4: Good Cop/Bad Cop : A Parental Problem 205
Sidebar 9 5: Makes Sense, But Does it Work? Part 2:
Preliminary Findings of the PE/MFG 207
Phase 4: Psychodynamic Family Therapy 208
Summary 209
References 210
Appendix: Suggested Psychoeducational Printed Materials, Videos,
Films, and Web Sites 215
Printed Materials 215
Overviews 215
Family Issues 216
Instructive Books 216
Newsletters 217
Videos 217
Films 217
World Wide Web 218
10 Interpersonal Group Therapy 219
Introduction 219
Indications 220
IPG Structure, Duration, and Leaders 221
Structure: Group Size and Meeting Schedule 221
Duration 222
Group Therapists 222
Getting the Group Started 223
Membership 223
Engagement 224
Sidebar 10 1: Makes Sense, But Does It Work?—Part 3: Preliminary Findings on
Efficacy of IPG 225
Establishing a Contract 226
Processes of Therapy 227
Interpersonal Learning 228
Cohesion 228
Owning and Expressing Hostilities 229
Split Treatment: Communicating With Primary Clinicians and
Other Therapists 231
Outside the Group Contacts 231
Summary 232
References 232
11 Individual Psychotherapies, Phase 1: Getting Started 235
Introduction 235
Getting Started 237
The Problem of Dropouts 237
Contracting Roles 238
Sidebar 11 1: Anticipating Problems in Psychotherapy 240
Structuring the Therapeutic Frame (External Boundaries) 242
Bills 243
Frequency 244
Scheduling 246
Seating 246
Sidebar 11 2: What Is the Role of Psychoanalysis for BPD Patients? 247
Therapists 248
Qualifications 248
Qualities 252
Sidebar 11 3: Listening to Kernberg or Linehan: Can Charisma Cure BPD? 253
Engagement 255
Summary 257
References 258
12 Individual Psychotherapies, Phases 2,3, and 4: Processes of Change 261
Prior Literature 262
Outcome Studies 262
Psychoanalytic Contributions 267
Sidebar 12 1: The Debate of the 1970s 269
Overview of Change Processes 270
Phase 2: A Relational Alliance 271
Phase 3: Positive Dependency 279
Sidebar 12 2: Transitional Objects From Concept to Phenomenon 279
Sidebar 12 3: Is Regression Therapeutic?—The Two Margarets 282
Phase 4: Secure Attachment, The Working Alliance, and Consolidation of Self 284
Impasses 285
Summary 287
References 288
13 Future Considerations 293
The Diagnosis: Self Disorder and Relationship to DSM IV Axes I and II 293
The Search for the Core Psychopathoiogy of
Borderline Personality Disorder 294
Brain Meets Mind: Frontiers for BPD in the Neurosciences 297
Sidebar 13 1: Is BPD a Brain Disease or Not? 297
Development of Specialists and Special Services 300
Credentialing Therapists 302
Standards of Care 303
Public Awareness and Advocacy 304
Sidebar 13 2: Borderline Personality Disorder on the Internet Proceed
Enthusiastically...With Caution 305
Sidebar 13 3: Were a Famous Borderline to Go Public... 307
The Swiss Foundation 308
Summary 309
References 309
Index 313
|
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| spelling | Gunderson, John G. Verfasser aut Borderline personality disorder a clinical guide John G. Gunderson 1. ed. Washington, DC [u.a.] American Psychiatric Publ. 2001 XXII, 329 S. graph. Darst. txt rdacontent n rdamedia nc rdacarrier Borderline persoonlijkheid gtt État-limite (Psychiatrie) Borderline Personality Disorder Borderline personality disorder Borderline-Persönlichkeitsstörung (DE-588)4007720-2 gnd rswk-swf Borderline-Persönlichkeitsstörung (DE-588)4007720-2 s DE-604 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009758298&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Gunderson, John G. Borderline personality disorder a clinical guide Borderline persoonlijkheid gtt État-limite (Psychiatrie) Borderline Personality Disorder Borderline personality disorder Borderline-Persönlichkeitsstörung (DE-588)4007720-2 gnd |
| subject_GND | (DE-588)4007720-2 |
| title | Borderline personality disorder a clinical guide |
| title_auth | Borderline personality disorder a clinical guide |
| title_exact_search | Borderline personality disorder a clinical guide |
| title_full | Borderline personality disorder a clinical guide John G. Gunderson |
| title_fullStr | Borderline personality disorder a clinical guide John G. Gunderson |
| title_full_unstemmed | Borderline personality disorder a clinical guide John G. Gunderson |
| title_short | Borderline personality disorder |
| title_sort | borderline personality disorder a clinical guide |
| title_sub | a clinical guide |
| topic | Borderline persoonlijkheid gtt État-limite (Psychiatrie) Borderline Personality Disorder Borderline personality disorder Borderline-Persönlichkeitsstörung (DE-588)4007720-2 gnd |
| topic_facet | Borderline persoonlijkheid État-limite (Psychiatrie) Borderline Personality Disorder Borderline personality disorder Borderline-Persönlichkeitsstörung |
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