Treatment Flashcards
1
Q
Treating a borderline functioning patient
A
Emphasis on the relationship, dynamic, and watching the relationship
- continually monitoring– ‘are you ok with what we’re talking about?’ , ‘is this feeling alright to you?’ – a major concern with the [therapeutic] alliance
- expectation of painful ruptures; a lot of the treatment will focus on repairing those ruptures
- patient is aware that they are a handful– treatment goes farther with a less neutral approach, ex: “what is like for you to see the anger on my face?”
- setting hard boundaries– what’re consequences of suicide or self-damaging actions?; ‘you can call me at these times if something happens’, yadda-yadda– therapist MUST stick with and to boundary
- asking patients what they wish for when they go silent “i don’t want you to feel as though i am abandoning you, when you go silent like this, how would you like me to respond?’
- expect INTENSE counter-transferences (not always negative)
2
Q
Treating a psychotic functioning patient
A
-can sometimes present as idealization to fear rather than idealization to devaluation; requires therapist to focus on safety– may require deviation from usual style
- style needs to both incorporate a down-to-earth “i’m just another person trying to help” with a slight aire of authority– a reassurance that you are competent in what you do, without coming off as snobbish; respect as a primary attitude; ‘you have something to teach me, i can learn something from you’
- emphasis on inside vs. outside
- detracting from focal more often than w/ neurotic or borderline– chat about your own life– being blank w this group makes them crazier
3
Q
Therapeutic advice
A
- first question should be: what brought you here / how can i help you?
- ask them how they understand their suffering? what is their own theory of why they’ve gone off the deep end/however they describe their current state
- ask kindly to write down what they say; explain it helps you organize your thought process
- ask w/in first hour ‘what is it you want to know about me?’
- typically patients’ questions link back to themselves and offer insight on what may be important to themself, too
- explain that the second session, you want a full intake; anything you don’t want to answer, don’t, but i’m gonna be really intrusive to develop a context
- second session typically has askings about substance use, eating disorders, sexual history, childhood stories and anecdotes of what they were like as a kid
- ask patient earliest memory
- indication of healthy organization / functioning v. others: if patient describes a 3-dimensional look at their parent ; unhealthy organizations/borderline-psychotic will describe parent in a black-and-white way: he was a monster, or, he’s just the best, i wanna be just like him!– an inability to bring the person to life
4
Q
“You could change the economics, but not the dynamics”
A
The goal of this therapy is to not change who the patient is, but to work towards having a much wider group of defenses, healthy, and not feel so rigid