Exposure Therapy by Peter Neudeck & Hans-Ulrich Wittchen

Author:Peter Neudeck & Hans-Ulrich Wittchen
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Maria is a 22-year-old woman with BPD. She reports cutting and alcohol abuse during acute emotional crisis, which often occurs in the context of interpersonal conflicts. When she goes clubbing with a new man, she often starts a sexual relationship quite quickly. In the beginning, she typically feels happy to make close contact with somebody, since she mostly feels lonely and abandoned. When a sexual interaction however starts, she is unable to set limits and tolerates sexual intercourse even when she doesn’t feel desire. During intercourse, she feels numb and often uses alcohol or drugs. Afterwards she hates herself, feels ashamed and guilty, and often cuts her legs in order to calm down and to punish herself. When she is in this state, her level of functioning declines, i.e., she holes up at home, spends all day with screen activities including impulsive online shopping, and is on sick leaves. Frequent sick leaves often cause conflicts at work, resulting in frequent job changes. Maria usually feels very helpless, but is hardly angry at the same time. However, when a relationship gets closer, she sometimes gets furiously enraged. Maria grew up in an unstable family, her father was an aggressive alcoholic and her mother did not dare leave him. At age 8–10, Maria was sexually abused by a friend of her father, who often served as her babysitter.

Maria’s sense of abandonment and her feelings of shame and guilt are conceptualized as vulnerable, abandoned child mode. Rage attacks are related to the angry child mode. Self-hate and self-cutting for the purpose of self-­punishment refer to the punitive parent mode, which developed probably due to the ­experiences of aggression by her father, and sexual abuse by one of his friends. Feeling numb and using alcohol to detach from unfavorable emotions belong to the detached protector mode. Her inability to set limits and her pattern of giving in to sexual contact she actually doesn’t want may be seen as compliant surrender mode, which was probably also modeled by her mother, who stayed with the father and sustained his aggression instead of leaving him.

The general goal of ST is to help the patient understand how dysfunctional schemas or schema modes have developed, how the patient is handicapped by these schemas and modes today, which needs have not been met during childhood, and how own needs can be adequately met today.

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