Borderline Personality Disorder: A Clinical Guide

Contents......Page 6
About the Authors......Page 12
Introduction......Page 14
Origins of the Diagnosis......Page 18
Shifts in the Borderline Construct: From Organization to Syndrome to Disorder......Page 22
An Explication of the DSM-IV Criteria......Page 26
A Clinical Synthesis: Intolerance of Aloneness......Page 35
Misuses of the Borderline Diagnosis......Page 39
The Behavioral Specialty: Self-Injurious Behavior......Page 41
How to Explain the Diagnosis......Page 44
References......Page 45
Overall Function......Page 54
The Changing Construct: From Schizophrenia to Depression to Posttraumatic Stress Disorder to Bipolar Disorder......Page 55
Comorbidity and Differential Diagnosis......Page 57
Summary......Page 76
References......Page 77
Historical Overview......Page 82
Generic Therapeutic Processes and the Functions They Serve......Page 84
Multiple Modalities and Step-Down Services: An Overview......Page 88
Establishing Goals: The Expectable Sequence of Change......Page 89
Changes Within Four Spheres......Page 94
The Initial Structuring of Treatment......Page 97
Types and Sequence of Therapeutic Alliance......Page 99
Countertransference......Page 101
References......Page 102
4 Case Management: The Primary Clinician......Page 106
Responsibilities......Page 107
Liability Issues......Page 109
Relationship Management......Page 110
Managing Safety......Page 111
Responding to Recurrent Suicidality: The Principle of False Submission......Page 119
Implementing Changes......Page 122
Boundaries, Violations, and Setting Limits......Page 123
Splits, Splitting, and the Virtues of Split Treatments......Page 124
Summary......Page 127
References......Page 128
5 Levels of Care: Indications, Structure, Staffing......Page 130
Selecting or Changing a Level of Care......Page 131
Level IV: Hospital Treatment—Makes Therapy Possible......Page 132
Level III: Residential/Partial Hospital Care/Day Treatment—Basic Socialization......Page 139
Level II: Intensive Outpatient Care—Behavioral Change......Page 147
Level I: Outpatient Care—Interpersonal Growth......Page 150
Summary......Page 151
References......Page 152
History......Page 156
Overall Role of Medications......Page 157
The Prescribing Psychiatrist’s Role......Page 160
Attitudes, Meanings, and Attributions......Page 165
Transference-Countertransference Issues......Page 166
Contraindications and Discontinuance......Page 168
References......Page 170
Pharmacotherapy Models......Page 174
The Symptom-Targeted Model......Page 175
Summary......Page 186
References......Page 187
8 Family Interventions and Therapies......Page 194
History......Page 195
Therapists and Countertransferences......Page 197
Getting Started: Overcoming Resistance......Page 198
Phase 1: Initial Family Meetings......Page 200
Phase 2: Establishing an Alliance......Page 204
Phase 3: Psychoeducational Family Therapy......Page 206
Phase 4: Psychodynamic Family Therapy......Page 213
Marital or Couples Therapy......Page 214
References......Page 218
Indications......Page 224
Engaging Patients and the Primary Clinician’s Role......Page 225
Skills Training Groups......Page 226
Psychodynamic Group Therapies......Page 231
Group Structure......Page 233
Common Problems......Page 235
References......Page 239
Introduction: Prerequisites......Page 242
Getting Started......Page 244
Structuring the Therapeutic Frame (External Boundaries)......Page 248
Therapists......Page 253
Engagement......Page 260
Generic Qualities of Effective Psychotherapies......Page 264
References......Page 267
Overview......Page 270
Basic Operant Conditioning Applications for All Treatment Settings......Page 272
Dialectical Behavior Therapy......Page 273
Cognitive Therapies......Page 284
References......Page 291
12 Psychodynamic Psychotherapies......Page 296
Pre-Empirical Developments......Page 297
Outcome Studies: Nonrandomized Trials......Page 299
Transference-Focused Psychotherapy......Page 303
Overview of Change Processes......Page 306
Phase 2: A Relational Alliance......Page 308
Phase 3: Positive Dependency......Page 315
Phase 4: Secure Attachment, the Working Alliance, and Consolidation of Self......Page 321
Impasses......Page 322
References......Page 324
Treatment Implications......Page 332
Diagnostic Implications......Page 335
Public Awareness and Advocacy......Page 338
Summary......Page 341
References......Page 342
Printed Materials......Page 346
Films......Page 348
Web Sites......Page 349
A......Page 354
B......Page 355
C......Page 357
E......Page 358
G......Page 359
K......Page 360
M......Page 361
P......Page 362
S......Page 364
V......Page 366
Z......Page 367