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)
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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
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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
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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

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