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Case Study 15: Borderline Personality Disorder
April 4, 2022
Introduction
Treatment of Borderline Personality Disorder (BPD) possess numerous challenges. Mental professionals, however, are adopting psychosocial methods, which are proving quite effective. Dialectical Behavior Therapy (DBT) is an intervention under cognitive behavioral therapy. It aims to point-out and modify negative thinking patterns and targets the adoption of positive emotions. The intervention approach by Dr Bank and Karen, in this case, can be used to manage the physical and psychological problems exhibited by patients with BPD and be used as an evidence-based experiment in the determination of various elements of the treatment of mental conditions and symptoms related to BPD. The case analysis will provide a framework for selecting and utilizing technology-based therapies, evaluating their potential risks, and recommending extra treatment interventions that can be used to interventions for mental health patients with similar conditions.
Explain the connection between each theoretical orientation used by Dr Banks and the interventions utilized in the case.
Mental health professionals need to align the interventions for the mental health condition to a theoretical framework to enhance their competency and ensure proper and quality outcomes for their patients. Dr Banks intervened the condition through a medication approach to enable Karen to cope with both physical and psychosocial burdens caused by BPD. Sneed et al. (2012) note that stimulants are one of the most effective intervention techniques to enable patients to focus on positive behaviors as well as regulate their negative behaviors. An added link between the theoretical framework and the intervention used in this case is evident in the behavioral changes to define the reward and incentive mechanism Karen enjoys in her mental treatment program. Usually, a mental health professional achieves the desired outcome by identifying the skills necessary for their patients to overcome the problems associated with their conditions.
Describe the concept of dialectical behavior therapy, being sure to include the six main points of this type of treatment.
Dialectical Behavioral Therapy is a therapeutic approach used to assist patients avoid negative behaviors and focus on positive ones. According to Rizvi et al. (2013), DBT is an effective approach for training patients’ essential mechanisms for improving their behavior and personality. It utilizes six elements in the model development essential to achieve the desired outcome. The first element is emotional dysregulation which focuses on the capacity of patients to regulate their emotional behavior and focus on positive emotions. Biological vulnerability is key to understanding the relationship between people’s emotional stimuli, their reaction to them and how the reduced recovery rate from emotional arousal led to behavioral problems. Skills deficiency prevents patients from keeping off from their misbehavior or seeking alternative behaviors if they have negative emotions. Behavioral skills training groups and individual psychotherapy sessions are the final elements of DPT required for enabling patients to develop quality behavioral skills by focusing on the most relevant events at a given moment.
Explain Dr Banks’s primary goal during the pre-treatment stage and how Dr Banks related this to Karen in her initial therapy sessions.
Dr Banks’ primary goal was to equip Karen with the necessary knowledge on the elements of therapy and the role they play in ensuring treatment objectives. The doctor was also concerned about the commitment of Karen to the treatment program for the period agreed to achieve different objectives. According to Harned et al. (2013), mental health patients must commit to the treatment plans as advised by their psychologists, especially when previous treatment plans have been unsuccessful. Hence Dr Banks’s main plan is to educate Karen about her previous behavior on the commitment to treatment which is necessary to avoid the reoccurrence of the condition and ensure a trustworthy relationship that would ensure the desired outcome.
Describe the two formats that Dr Banks told Karen would be part of her treatment program
Dr Banks’ treatment program entails exposing the patient to imagined trauma, a technique that facilitates the elimination of memories which lead to trauma. Additionally, Karen is expected to focus on positive emotions to ensure the elimination of suicidal ideation and other negative emotions that may impede the desired outcomes of the treatment program. Karen hence received a weekly engagement in a group therapy to train her on the ability to control her impulse and regulate her negative emotions.
Describe the focus of the second and third stages of treatment
In the second stage, Dr Bank’s main focus was assisting Karen get over her emotional distress from her past traumatic events. The psychologist employed the exposure technique to treat PTSD. The treatment stage entailed focusing on techniques that can enable Karen to gain skills for raising self-confidence and personal goals. The overall treatment plan consolidates each treatment stage to attain the overall goals.
Assume the role of a consulting clinical or counselling psychologist on this case, and recommend at least one technology-based e-therapy tool that would be useful.
As a counselling psychologist, I would use video teleconferencing to aid Karen deal with some of the challenges related to BPD. Conducting therapy sessions via a digital platform could enable Karen to gain significant confidence and subsequently be ready to attend face-to-face meetings. It is also an essential platform for her to gain trust with the therapist. Additionally, it would complement the positive outcomes derived from previous use of other methods for enabling the patient to overcome behavioral changes.
Assume the role of a consulting clinical or counselling psychologist on this case, and recommend at least one technology-based e-therapy tool that would be useful.
Miller (2006) notes that psychologists must be careful while using telehealth tools in their treatment plans to avoid potential risks that might interfere with the program. While video teleconferencing would enhance the treatment plan, it would also create concerns about privacy and informed consent issues, which would be detrimental to the treatment process. Additionally, it would be vital for the visiting psychologist to identify the potential risks of the patient’s history to impact the psychometric data before employing digital therapy.
Evaluate the effectiveness of the treatment interventions implemented by Dr Banks, supporting your statements with information from the case and two to three peer-reviewed articles
The treatment outcome by the patient after the two years of therapy issued by Dr Banks indicates that the treatment intervention program employed is valid and effective for the management of behavioral problems. Employing behavioral therapy for patients suffering from mental health conditions is essential to prevent and eliminate the severity of the condition that might even lead to the death of the patient (Luxton et al.,2011). The effectiveness of the intervention is seen in the patient’s part-time employment and the fact that she has begun to forget her childhood traumas.
Recommend three additional treatment interventions that would be appropriate in this case. Use information from the Sneed, Fertuck, Kanellopoulos, and Culang-Reinlieb (2012) “Borderline Personality Disorder” article to help support your recommendations. Justify your selections with information from the case.
Some additional recommendation therapies include Mentalization-Based treatment (MBT).MBT is an integrative treatment approach that is used for the treatment of severe BPD. It focuses on how people coherently manage their emotions and thoughts. Transference-focused therapy is an approach that focuses on identifying borderline conditions and researching new and better ways to enable a patient to think and behave positively. Cognitive-based therapy is vital in assisting a patient in changing their thinking patterns. According to Sneed et al. (2012), these three approaches compare in their effectiveness with DPT but differ in their stress on psychoanalysis and utilization of attachment theories principles. Dr Bank can employ these approaches through supervising the patient’s level of attachment to specific items and utilizing the information in forming mental images to raise the patient’s ability to see positive images and participate in creative activities. A collaborative intervention of the three techniques alongside DPT would enhance the patient’s ability to control her impulses and ultimately develop positive thinking patterns.
Conclusion
DPT is very reliable in the treatment of BPT; the intervention can enable patients to overcome negative thinking patterns. As noted in Karen’s case, interference with the treatment plan would significantly affect the treatment objectives. The utilization of various elements of DPT in Karen’s three-stage treatment process played an essential role in facilitating positive outcomes. Telehealth tools can aid in the treatment process upon consideration of some liabilities. Employing extra effective intervention for a mental condition can enhance the treatment process.
References
Harned, M. S., Tkachuck, M. A., & Youngberg, K. A. (2013). Treatment preference among suicidal and self‐injuring women with borderline personality disorder and PTSD. Journal of clinical psychology, 69(7), 749-761.
Luxton, D. D., McCann, R. A., Bush, N. E., Mishkind, M. C., & Reger, G. M. (2011). M Health for mental health: Integrating smartphone technology in behavioral healthcare. Professional Psychology: Research and Practice, 42(6), 505.
Miller, T. W. (2006). Telehealth issues in consulting psychology practice. Consulting Psychology Journal: Practice and Research, 58(2), 82.
Rizvi, S. L., Steffel, L. M., & Carson-Wong, A. (2013). An overview of dialectical behavior therapy for professional psychologists. Professional Psychology: Research and Practice, 44(2), 73.
Sneed, J. R., Fertuck, E. A., Kanellopoulos, D., & Culang-Reinlieb, M. E. (2012). Borderline personality disorder.