Treatment of Borderline Personality Disorder by Paris Joel

Author:Paris, Joel. [Paris, Joel.]
Language: eng
Format: epub, pdf
Published: 0101-01-01T00:00:00+00:00

Mary was prescribed haldoperidol, citalopram, lamotrigine,

and clonazepam. None of these drugs helped her. Several of her

previous therapists became burned out by her difficulties.

Mary’s parents were alcoholic, and her mother left home

when she was 11. After being expelled from high school, Mary

had a very irregular and tumultuous life, which became worse

after the breakup of a long-term relationship when she was 25.

Mary made little progress in our program. She returned to

long-term outpatient care and went on to have several other ad-

missions to hospital.

Case 9

Norma was a 29-year-old woman who had never held a job.

Since the age of 18, her life had centered around her many (25)

hospital admissions and frequent (weekly) emergency room vis-

its. Norma’s mood was unstable, and she had an explosive tem-

per. Overdoses were carried out in the face of frustration, and

Norma also cut herself from time to time. She heard voices in

her head telling her to die but was not sure if they were real.

Norma developed a reputation for being an emergency

room problem because of her threats of violence. On one occa-

sion she pushed an experienced emergency psychiatrist against a

wall and was barred from ever attending that hospital again.

Case 10

Tania was a 37-year-old woman who has been in psychiatric

treatment since the age of 20. Although Tania came from a fam-

ily of professors, she was currently living alone on welfare, and

her social life was limited to a few friends and family.

Tania had seen many therapists in the past. Her concerned

parents had made an effort to link her to well-known clinicians

in the community. All of them had eventually given up in frustra-

tion. Currently, Tania was attending a psychiatric clinic where

she saw a psychiatrist who evaluated her and prescribed paroxe-

166

T R E A T M E N T

tine, desipramine, clonazepam, and valproate. But she was still

hoping to find the “right” therapist.

Tania was an intelligent woman who had come close to fin-

ishing her university degree. Unlike patients with BPD who dra-

matize their symptoms, Tania had learned over the years to pres-

ent herself as healthier than she was in order to be accepted by

therapists. She could never be counted on to provide an accurate

picture of her problems. On one occasion when I evaluated her,

Tania described social isolation and little else. Yet she had been

quite recently admitted to a ward where she spent 6 months and

where her suicidality as well as violent regressed behavior made

enormous difficulties for the staff.

BRIEF INTERVENTIONS AND EXTENDED CARE

The received wisdom about BPD used to be that treatment should al-

most always be long term. Intuitively, it seems logical to assume that

patients with long-term problems need extended courses of therapy.

Although this point of view originated in psychoanalysis, cognitive

therapists share it. Linehan (1993) proposed a treatment lasting for

years, as did Beck, Freeman, Davis, and associates (2004).

The outcome research reviewed in Chapter 6 points in a differ-

ent direction. Many cases of BPD remit symptomatically within a

few years, and quite a few do well in the long run. Moreover, some of

the clinical trials discussed in Chapter 8 (e.g., Davidson, Norrie, et

al., 2006; Stanley et al., 2007) suggest that good results can some-

times be obtained in a few months.

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