See You Next Swing
Mental Health matters: They will walk out on you now! Be back next Swing!! (As in mood swings).
It is a patient's right that if he is not satisfied with his treatment, to have it discontinued. After which, it is normal to expect that the patient will not visit that particular doctor's clinic anymore. But not so if the patient is a BPD (Borderline Personality Disorder). Such a person, chances are, will turn up like a bad penny at the clinic. Certainly he will avoid the psychotherapist (from now on it will be a "I Hate You / Don' t leave me" relationship" by Jerold Kriesman and Hal Straus')whose therapy he has just left. But he might call on the other psychotherapists there, or the staff members ,or the group therapy session. If he likes the clinic/hospital he will just visit there. The same with learning new skills .Some hospitals may not have DBT(Dialectical Behavior Therapy),which employ the learning of new skills; hence they might have rooms with some other techniques to relax, some skills like Ikebana, learning the computer or even learning how to make things of art out of clay.
Can you imagine a person not on the hospital's list being welcome at any of the places mentioned above? At many no nonsense places, such patients maybe very modestly shoo-ed away. But in this very TENDENCY(the patient keeps visiting the hospital again and again) lies the hope. If this tendency is used for such patients instead of against them it would be extremely beneficial to all concerned. I implore. May this word have sufficient "punch packed" in it to make you appreciate the intensity of my argument. If a BPD would very one sidedly decide to discontinue the treatment; I implore that the psychotherapist would not regard it as discontinued. He should just assume a remote position and monitor his patient's affairs from here. The psychotherapy clinic should soften, and bend the barriers (Rules), and indeed remove them and let this patient in. Such patient's records would be maintained differently. Also a full database of his statistics should be readily available as online spatial information to any psychotherapist needing it; especially to address the issue of treatment drop outs.
All the psychotherapists and staff should work as a team, and not lose this patient. All activities should be cleverly shepherded towards his getting therapy from a psychotherapist eventually. There should be freedom for him to come as and when he pleases, and an INSTITUTION centered therapy approach. He knows if he is annoyed with the institution, it will never shout back at him, moreover it is stocked with all goodies (music, painting, games, books and his "group therapy session friends")which he can always get without being reproached. I am very optimistic this different approach will pay in the long run. Now I would like you to read the highlights I have lined up for you so that you can see why those (psychotherapy staff) who are expected to provide help to the mentally distressed simply cannot come to the rescue of many BPDs who suffer from very real distress beyond their control.
The Psychotherapy Clinic's Window View of the BPD Case (some highlights):
-"Traits involving emotions: Quite frequently people with BPD have a very hard time controlling their emotions. They may feel ruled by them. One researcher (Marsha Linehan) said, "People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement." "
– From Sorensen; Common features of borderline personality disorder. These are as following;
"Chronic emotional lability;"Self harm;" "Mood swings;"
("Emotional lability is a classic feature of BPD. Moods can shift rapidly – even minute to minute – with no obvious reason which the onlooker can understand".)
"Dysphoria;""Psychosis";"Splitting"; and "Co-morbidity."
I would like to say, because of these s/s the BPDs leave their houses, jobs and clinics frequently.Also because of these signs/symptoms they have a make- or- break cycle of relations with their families, friends, acquaintances, workmates and their therapist and his caregivers staff.
-" Although there is general agreement concerning the diagnostic features of BPD its' Aetiology and treatment have become the focus of considerable debate over recent years".
-Joel; "Personality disorders affect about 10% of the general population.(10 per cent???!!!! This into the rest of the population per cent like a colossal jarring from a gigantic tuning fork!) DSM-IV defines ten categories of personality disorder. Of these, Borderline Personality Disorder (BPD) is THE MOST FREQUENT in clinical practice. BPD is also one of THE MOST DIFFICULT AND TROUBLING in all of psychiatry".
-Joel; "Most often, borderline patients present to psychiatrists with REPETITIVE suicidal attempts".
-Joel; "Interpersonal relationships in BPD are PARTICULARLY UNSTABLE. Their emotional life is a kind of rollercoaster."
-Joel;" The level of long term improvement in borderline patients varies a great deal. In the MAJORITY of cases, both impulsivity and emotional instability DECLINE over time, and the patient is eventually able to function at a reasonable level".( I say, yeah give him a chance let him hang out at the psychotherapeutic clinic for as long as it takes.)
-Sorensen;' Serotonin'-" It is interesting to note that many researchers have identified serotonergic dysfunction in the brains of BPDs. This may have marked implications for the maintenance of mood and also go some way towards explaining the frustration and rage ROUTINELY exhibited by sufferers (Siever L.J. 1997)".
– PORR She has said it all!!!—- "People with BPD can be helped by combining sensitive and up to date pharmacological treatment and effective new methods of cognitive therapy. This will keep patients out of expensive hospital beds and help them back into meaningful roles in the community. Why would our society choose to ignore what can work to help people whose neurobiological disorder causes them to wreak havoc on themselves, bring despair to their families, create problems in the work place, fill our prisons and jails, clog our courts with stalkers and lengthy divorce and child custody battles, and burn out therapists faster than our schools can turn them out?"
-Sorensen; "It is NO SECRET that this particular client group can be something of A NIGHTMARE when it comes to finding effective therapeutic interventions. The treatment of BPD is fraught with DIFFICULTY, particularly in an in-patient setting where many borderline behaviors result in discord among the STAFF or where the demands made upon an INDIVIDUAL NURSE can become extremely unrealistic."
-Joel; "The mainstay of treatment for BPD has always been, and continues to be psychotherapy. However, because of their impulsivity, about two thirds of borderline patients DROP OUT of treatment within a few months. Those patients who stay in therapy will usually improve slowly over time."
This is the most suitable therapy for the BPD.The case rests here:
Elizabeth T. Murphy; "Dialectical Behavior Therapy, often referred to as DBT, is an empirically researched psychotherapeutic treatment developed by Dr. Marsha Linehan, Professor of Psychology, University of Washington, for patients struggling with chronic suicidality, intentional self-harm and borderline personality disorder (BPD). This therapy, employing cognitive and behavioral principles, is rapidly becoming a standard for treating borderline patients in both this country and abroad. DBT consists of two primary components involving individual psychotherapy once a week and a weekly skills training group. Additionally, patients are offered telephone consultations with their individual therapist as needed."
Foggy is a GP and interested in writing poetry and finding solutions for environmental problems.
foggy
July 9, 2009 at 6:11 pm
Add some for DBT
What Is Dialectical Behavior Therapy Used For?
DBT is designed for use by people who have urges to harm themselves, such as those who self-injure or who have suicidal thoughts and feelings. It was originally intended for people with borderline personality disorder, but has since been adapted for other conditions where the patient exhibits self-destructive behavior, such as eating disorders and substance abuse.(http://depression.about.com/od/psychotherapy/a/dialectical.htm)
From this, one can easily see if more and more DBT clinics spring up in our cities, it will make a big reference base.
a)those GPs who think their patients have BPD,will refer them to the clinics, for screening and confirming diagnosis.
b)those psychotherapists who themselves do not practise DBT but would like thir BPD patients to get that, would send them to these clinics.
c)BPDs who are psychotherapy and TAU(Treatment as usual)dropouts currently will indirectly or directly turn up at these clinics.
d)others like self destructive behaviors/ eating disorders, similarly might get referred.so also normal people who wish to benefit from new skills might, themselves simply get enrolled at the-DBT department, handling the practicals part for the acquiring of "Skills Training – Attending skills groups, doing homework assignments and role playing new ways of interacting with people."(getting ready for interviews,auditions for stage or TV acting (http://depression.about.com/od/psychotherapy/a/dialectical.htm).