Psychotherapy With Personality Disorders

psychotherapy With Personality Disorderscollege Of Nursing Pmhnp Wal

Individuals with personality disorders often struggle to overcome persistent patterns of thinking and behaviors that affect their daily lives. When patients recognize that their personality-related issues are causing significant suffering and are open to therapy, treatment can be challenging for both the patient and the therapist. This paper focuses on borderline personality disorder (BPD) and its psychotherapeutic management.

Borderline personality disorder (F60.3) is characterized by a pattern of instability in interpersonal relationships, issues with self-image, impulsive behaviors, and at least five of the following symptoms: fear of abandonment, unstable and intense relationships, identity disturbance, impulsivity in harmful activities, self-harm and suicidal behaviors, severe mood swings, feelings of emptiness, anger, and brief paranoid or dissociative episodes (APA, 2013). These features contribute to significant distress and impairment in functioning.

Dialectical Behavioral Therapy (DBT), developed as a modification of cognitive-behavioral therapy (CBT), emphasizes balancing acceptance and change through validation and problem-solving techniques. DBT recognizes three stages of treatment: addressing life-threatening behaviors, improving quality of life, and developing a deeper sense of self. This approach is evidence-based and is particularly effective in reducing self-harm and suicidal behaviors among individuals with BPD (Gold, 2021). Notably, research indicates that DBT decreases hospitalizations and overdoses in patients with BPD, reinforcing its efficacy as a specialized treatment (Gold, 2021).

Building a strong therapeutic relationship is fundamental in treating BPD. A collaborative and trust-based alliance facilitates engagement, openness, and adherence to treatment plans. Factors that hinder this relationship include environmental instability and patient mistrust. Therefore, therapists need to foster a stable, non-judgmental, and empathetic environment to ensure positive outcomes. Strategies such as individual therapy, skills groups, provider consultations, and structured environments contribute to the effectiveness of DBT (Bolsinger et al., 2020; Keller et al., 2017).

In clinical practice, disclosing a diagnosis like BPD requires careful, client-centered communication. The therapist should inquire about the patient's understanding of their symptoms based on DSM criteria, provide psychoeducation about the disorder, and offer support resources. Establishing a respectful and sensitive dialogue ensures that the patient feels supported and engaged in their treatment journey. Connecting the diagnosis to the client's personal goals and beliefs enhances motivation and compliance (Austin & Butler, 2017).

The impact of BPD extends beyond individuals to their families, affecting their mental and physical health. Research demonstrates that psychoeducation and family therapy can significantly improve family dynamics, conflict resolution, and reduce caregiver stress. Group therapy offers additional benefits by reducing isolation, fostering peer support, and encouraging skill development in managing symptoms and relationships (Jaber et al., 2021; Keller et al., 2017).

In conclusion, effective management of BPD involves a multifaceted approach that includes patience, support, psychoeducation, and therapeutic resources. Establishing a strong therapeutic relationship is critical to promoting client progress across individual, family, and group interventions. Integrating evidence-based treatments like DBT and fostering supportive environments can significantly improve outcomes, leading to enhanced well-being for clients and their families.

References

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
  • Austin, S., & Butler, S. (2017). Disclosing & discussing “difficult” mental health diagnoses. Society for the Advancement of Psychotherapy.
  • Bolsinger, J., Jaeger, M., Hoff, P., & Theodoridou, A. (2020). Challenges and opportunities in building and maintaining a good therapeutic relationship in acute psychiatric settings: A narrative review. Frontiers in Psychiatry, 10.
  • Gold, A. L. (2021). Building commitment to change: Lessons from DBT. Brown University Child & Adolescent Behavior Letter, 37(3), 1–4.
  • Jaber, A., David, P., Berube, F. A., Perusse, F., Busque, H., Noiseux-Lescop, N., & Cailhol, L. (2021). Évaluation d’une thérapie comportementale dialectique auprès de proches de personnes considérées atteintes du trouble de la personnalité limite. L’évolution Psychiatrique, 86(1), 67–76.
  • Keller, S., Page, D., de Roten, Y., Despland, J. N., Caspar, F., & Kramer, U. (2017). Adaptation of the Motive-Oriented Therapeutic Relationship Scale to group setting in dialectical-behavioral therapy for borderline personality disorder. Journal of Psychotherapy Integration, 27(1), 47–58.
  • Research sources, 2021. All citations are based on scholarly articles and clinical guidelines related to BPD and DBT.

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