Borderline personality disorder : a practical guide to treatment / Roy Krawitz, Christine Watson.

Format:

Book

Author/Creator:

Krawitz, Roy.

Contributor:

Watson, Christine, 1950-

Language:

English

Subjects (All):

Borderline personality disorder--Treatment.

Borderline personality disorder.

Borderline Personality Disorder--therapy.

Medical Subjects:

Borderline Personality Disorder--therapy.

Physical Description:

xvi, 201 pages : illustrations ; 22 cm

Place of Publication:

Oxford ; New York : Oxford University Press, 2003.

Summary:

Borderline personality disorder is a multidimensional disorder best considered as severe personality dysfunction. Around 2% of the population are thought to meet the criteria for the disorder, with approximately 1 in 10,000 people experiencing the most severe difficulties. This group is over-represented in the challenges facing mental health services. Once seen as 'untreatable', people meeting diagnostic criteria for borderline personality disorder are all too often mistreated and misdiagnosed, resulting in prolonged and unhelpful relationships with support services that are taxing to patients and clinicians alike. Borderline personality disorder: a practical guide to treatment draws on the latest research and clinical experience to provide an accessible and practical summary of treatment options for clinical management and treatment. It provides hope and evidence that people meeting diagnostic criteria for the disorder can be treated effectively and successfully. The book presents a pragmatic approach to care to be read by all members of mental health and substance use teams including psychiatrists, clinical psychologists, counsellors, mental health nurses, and social workers.

Contents:

Terminology xi

Part 1 Background to treatment

Origins of the label "borderline personality disorder" 3

History of treatment 4

Epidemiology 4

Diagnosis 6

Comorbidity 9

Clinical boundaries 11

Aetiology 13

Prognosis 15

Morbidity and mortality 18

Health resource usage 19

Health resource use after effective treatment 20

Different treatment models 21

Psychodynamic and psychoanalytically informed psychotherapy 21

Self psychology 23

Relationship management 24

Cognitive analytical therapy (CAT) 24

Cognitive-behavioural therapies 26

Dialectical behavior therapy (DBT) 26

Commonalities between different models 29

Multimodel approach 30

An organizing clinical framework for mental health clinicians 31

Outcome studies 34

Psychosocial treatments 34

Pharmacological treatments 40

Serotonergic agents 41

Neuroleptic agents 42

Anticonvulsants 42

Older agents (tricyclic antidepressants, older MAOIs) 42

Other agents 43

Prescribing in the acute situation 44

Part 2 Treatment issues and clinical pathways

Assessment 49

Risk assessment 54

Differentiating acute and chronic suicidal and self-harm patterns 54

Crisis assessment 56

Interventions 58

Client-clinician relationship 58

Team/system culture 58

Clinical plan 59

Duration of treatment 69

Prioritizing interventions 69

Empathy and validation 71

Containment/holding 72

Transitional people and items 73

Self-harm 74

Contracts 80

Crisis work 81

Regression at times of crisis 83

Some anti-suicide interventions 84

Acute inpatient services 85

Client-controlled brief acute admissions 91

Pragmatic conceptual frameworks guiding treatment 94

Cognitive behavioural strategies 101

Behaviour chain and solution analysis 107

Teams 112

Team structure 112

Investing value and status in the key clinician role 114

Specialist teams 115

Systems 116

Responsiveness of the organization to clinician needs 116

Staff differences 118

Residential treatment 123

Relatives and friends 125

Principles of effective treatment 127

Part 3 Stigma, language, clinician feelings, and resourcing

Stigma and discrimination 133

Language

negative terminology 134

Clinician values and feelings 135

Resourcing 137

Part 4 The legal environment

Medicolegal framework 141

Duty of care and institutional responsibilities 142

Professionally indicated risk-taking 145

Clinical appropriateness of the use of mental health legislation 158

Part 5 Maintaining enthusiasm

Limit-setting 163

Preventing clinician burn-out 165

Supervision 170

Words of hope from clients 171.

Notes:

Includes bibliographical references (pages [183]-196 and index.

ISBN:

0198520670

OCLC:

53224792