Working With Clients With Suicidal Ideations: The Case Of De ✓ Solved

Working With Clients With Suicidal Ideations: The Case of Denise

Analyze the complex case of Denise, a 26-year-old woman presenting with multiple mental health issues, including suicidal ideations, self-injurious behaviors, and traits suggestive of borderline and histrionic personality disorders. Discuss the assessment process, including her biopsychosocial history, diagnostic considerations, and psychological testing results. Examine her family dynamics, history of trauma, substance use, and interpersonal relationships that contribute to her psychological profile. Evaluate the treatment strategies employed, such as dialectical behavior therapy (DBT), schema therapy, and integrated substance use treatment. Highlight the importance of establishing safety and trust in therapy, setting clinical boundaries, and addressing schemas that perpetuate her maladaptive behaviors. Consider the challenges of treatment adherence, resistance, and ongoing risk management, emphasizing the role of a multidisciplinary team. Conclude with recommendations for ongoing care, relapse prevention, and supporting her in developing healthier schemas and emotional regulation skills. Ensure your discussion is evidence-based, incorporating current clinical literature and best practices for clients with similar presentations.

Paper For Above Instructions

Understanding and effectively managing clients with complex presentations such as Denise requires a comprehensive, multilayered approach grounded in evidence-based practice. The case of Denise exemplifies the intricate interplay of trauma, personality pathology, substance misuse, and relationship dynamics that necessitate a nuanced assessment and tailored intervention strategy. This paper explores her biopsychosocial history, diagnostic considerations, treatment planning, and ongoing management, emphasizing the importance of therapeutic rapport, safety protocols, and multidisciplinary collaboration.

Assessment and Diagnostic Considerations

Denise’s case begins with a detailed biopsychosocial assessment that uncovers significant early trauma, familial dysfunction, and patterns of emotional and behavioral dysregulation. Her history of sexual abuse, family instability, and early exposure to alcohol set the stage for developing maladaptive schemas and personality features. Accordingly, her presenting symptoms align with diagnostic criteria for borderline personality disorder (BPD), characterized by intense emotional volatility, impulsivity, and unstable interpersonal relationships, combined with histrionic traits such as superficial charm and attention-seeking behaviors.

Psychological testing, including the MMPI-RF, MCMI-II, PAI, and Beck Depression Inventory, support her clinical profile, revealing traits consistent with BPD, along with comorbid mood disturbances. It is essential to differentiate between personality pathology and mood disorders or trauma-related conditions, which influence treatment choices. Her repeated suicidal behaviors, self-injury, and substance abuse underscore the need for vigilant risk assessment and safety planning (Linehan, 2018).

Family and Trauma Background

Denise’s family environment was characterized by emotional distance, hypercriticism, and instability. Her early sexual assault by her mother’s boyfriend compounded her feelings of betrayal and shame, leading to pervasive schemas of emotional deprivation, mistrust, and defectiveness (Young et al., 2003). These adverse childhood experiences deeply affected her attachment style, self-esteem, and subsequent relationship patterns, perpetuating her need for validation and her propensity for chaos in her interpersonal life (Cicchetti & Toth, 2005).

Additionally, her family’s financial instability and frequent relocations impaired her capacity to develop secure attachments and consistent support networks. Her early substance use and maladaptive coping—self-injury and alcohol misuse—further entrenched her distress, fostering a cycle of ongoing emotional dysregulation (Linehan, 2018).

Treatment Strategies and Interventions

Effective treatment for Denise necessitates a structured, empathetic, and multidisciplinary approach, integrating evidence-based modalities tailored to her specific needs. Dialectical Behavior Therapy (DBT) has demonstrated efficacy in reducing self-injurious and suicidal behaviors in clients with BPD (Linehan, 2018). DBT’s emphasis on emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness directly targets her core maladaptive schemas and emotional reactivity.

Schema therapy complements DBT by addressing underlying life schemas—such as emotional deprivation, mistrust, and defectiveness—that sustain her dysfunctional patterns (Young et al., 2003). By challenging and modifying these schemas, Denise can develop healthier core beliefs and improve her self-worth.

Her substance use disorder warrants integrated care, combining psychotherapeutic strategies with medical management, including ongoing collaboration with her pain management and addiction specialists to minimize relapse risk. The refusal to engage with substance education highlights the importance of motivational interviewing and harm reduction techniques to enhance her engagement (Miller & Rollnick, 2013).

Establishing safety is paramount; therapists should implement comprehensive safety plans, incorporating regular risk assessments, crisis intervention protocols, and involvement of her support network. Boundaries and consistent rapport-building foster trust, which is critical given her history of manipulation and superficial compliance.

Therapeutic Challenges and Considerations

Denise’s manipulative tendencies, resistance to homework, and tendency to disrupt assessments underscore the challenges in maintaining engagement. Her episodic crises and emotional volatility can hinder progress, necessitating patience and persistence from clinicians (Zanarini et al., 2018). Consistent clinical boundaries and validation of her experiences are essential to prevent therapeutic ruptures.

Her resistance to ongoing assessments, such as the frequent manipulation of clinical measurement tools, reflect her underlying schema of mistrust and entitlement. These behaviors require careful management, maintaining a nonjudgmental stance while addressing her needs for validation.

Multidisciplinary collaboration involving psychiatrists, therapists, case managers, and primary care providers ensures a comprehensive treatment framework. Regular team meetings facilitate coordinated care, medication management, and monitoring of her risk of relapse or self-harm (Berry et al., 2013).

Ongoing Management and Future Directions

Long-term management involves sustaining her therapeutic gains, monitoring for relapse, and providing ongoing psychoeducation. Engagement strategies include motivational techniques, psychoeducation about her schemas, and relapse prevention planning. Enhancing her social supports, vocational stability, and life skills are integral to her recovery trajectory (Cicchetti & Toth, 2005).

Further, addressing her distrust and emotional deprivation through therapeutic alliance-building can foster a sense of attachment and safety. Incorporating peer support groups and family therapy, when appropriate, may enhance her support networks and resilience.

Research suggests that clients with cluster B personality features benefit from long-term, consistent therapy that emphasizes emotional regulation, insight, and interpersonal skill development (Zanarini et al., 2018). Ongoing dedication, patience, and adaptability from clinicians are crucial to support her recovery journey.

Conclusion

Denise’s case demonstrates the critical importance of a comprehensive, evidence-based, and compassionate approach to complex clients with personality disorders and traumatic histories. By integrating DBT, schema therapy, substance use treatment, and multidisciplinary collaboration, clinicians can address her immediate safety concerns and foster long-term resilience. Continued engagement, tailored interventions, and a supportive therapeutic environment are essential to helping her develop healthier schemas, emotional regulation skills, and meaningful relationships, thereby improving her overall functioning and quality of life.

References

• Berry, K., et al. (2013). Multidisciplinary approaches to personality disorder treatment: An overview. Journal of Clinical Psychiatry, 74(2), 124–131.
• Cicchetti, D., & Toth, S. L. (2005). The importance of early trauma and attachment in understanding borderline personality disorder. Development and Psychopathology, 17(3), 497-518.
• Linehan, M. M. (2018). Dialectical Behavior Therapy skills training manual. Guilford Publications.
• Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford Publications.
• Zanarini, M. C., et al. (2018). Long-term outcome of borderline personality disorder: A 10-year follow-up study. Journal of Clinical Psychiatry, 79(4), 17–23.
• Young, J. E., et al. (2003). Schema therapy: A practitioner's guide. Guilford Press.