I think you will have to do a lot of research into the treatment of BPD. My take on it is that BPD is one of the most difficult of all the disorders to treat.
During my research, I found this from a hand book for therapists, written by the Disability Policy and Studies office of the School of Health Professions at the University of Missouri.
Borderline Personality Disorder
The main features of this personality disorder are unstable self-image, unstable interpersonal relationships, and unstable mood. People with this order are usually uncertain about their sexual orientation, their goals in life, the types of friends they prefer, and other aspects of self-image.
Individuals with borderline disorder see the world as a threatening, unfriendly place. Behaviour that seems manipulative to other people, they may see as what it takes to get by or as necessary for personal survival in a dangerous world. They also may seem to live in a state of repetitive crises. They often have a history of being victims, either of some type of abuse or some type of
crime, and they view themselves as victims. However, this sense of threat and danger can be situational, which means their behaviour can also be different in different situations or in response to different stressors. Some researchers refer to this “dependency on the mood state of the moment”: the individual may be very capable of dealing with certain situations, but challenged by other situations. The individual’s medical history may show a variety of diagnoses or symptoms (depression, somatic complaints, anxiety) reflecting the variety of responses.
One of the more striking features of individuals with borderline personality is how quickly they change their opinions about someone. They tend to see individuals in absolute terms as either great or horrible and will switch from one opinion to the other quickly. They show a pattern of intense, manipulative, demanding attachment in their relationships, swiftly changing to disappointment or anger with the other person. They can be supportive and nurturing, but demand equally strong support in return. They deeply fear abandonment and may lash out angrily if when they feel dissatisfied with a relationship. One consequence of these feelings is frequent changes in doctors, counsellors and other service providers.
These individuals have difficulty controlling impulsive behaviour and may have a history of problems with debt, shoplifting, reckless driving, substance abuse, fighting, self-mutilation, and suicide attempts. The individual may also have body piercings and tattoos.
Some VR counsellors actively avoid working with individuals with borderline personality disorder because they can be so challenging and frustrating. However, experienced counsellors report that, with the right approach, it is possible to successfully provide services and find careers for people with borderline personality disorder. Counsellors who have been successful with individuals with this disorder give the following advice:
Discuss the person and their case with your supervisor as early in the process as possible. These individuals are likely to try to manipulate the system by going over the head of the VRC, filing numerous complaints, or disrupting the office to manipulate the VRC. Having firm administrative support is crucial to maintaining control.
Document your contacts with the individual, the things the two of you agreed upon, and the actions you have taken. This documentation will give your supervisor information with which to respond to any challenges or complaints.
Set very clear, firm boundaries about what you will and will not do as a VR counsellor, and explain them clearly to the person. Do not become an advocate for the person beyond the role of the VR counsellor. Do not respond to their anger when you are firm about the boundaries. Eventually they will come to trust and take comfort in those boundaries, but only after testing them.
Do not interact with the client socially or romantically. The individual may behave very friendly or seductively toward you, but involvement with any client beyond the scope of the VR relationship is both unethical and unwise.
Expect that there will be times when the person will anger you, frustrate you, and possibly make you cry. Knowing it is likely will help you move past it when it happens.
Try a new intervention. If possible, locate a therapist (for the person) who uses Marsha Linehan's Dialectical Behavioural Therapy approach (see below).
Treatment. Treatment of individuals with borderline disorder is always a challenge. Treatment may sometimes involve medication, but the type of medication used can vary widely depending on the individual’s situation. Individual and group therapy is a more common approach.
Recently some therapists have reported significant progress with Dialectical Behavioural Therapy (DBT). This approach was created by Marsha Linehan at the University of Washington. It proposes that individuals with borderline disorder are constantly swinging between extremes of, among other things, feeling that they must control themselves and their emotions and feeling the need to express their strong emotions to others. They also swing between seeking someone to solve problems for them and trying to appear competent at managing their life. The term “dialectical” in the name of the therapy refers to the use of these and other sets of opposing forces in framing the approach.
DBT uses a system of structured boundaries, validation, positive and negative reinforcement, and social skills training, which is implemented in a combination of individual and group therapy settings. The goal is to help the individual better manage his or her feelings and problem-solve social situations in more adaptive ways. In addition to therapy for the individual, the therapist is engaged in his or her own DBT therapy with other therapists to help prevent burnout.
The DBT approach is getting support from many therapists and some medical schools require that all psychiatry students study it. It is unlikely that a VR counsellor will conduct DBT therapy himself or herself, but they may wish to find a therapist familiar with DBT for the individual. More information is available online at
www.dbt-seattle.com.
Placement Issues. The VR counsellor needs to be aware of the “all or nothing” fluidity of the person’s attitude. The counsellor should try to be an emotional “rock” to help the person anchor the chaos of their feelings. The individual may also “muddy the water” by trying to start a personal relationship with the counsellor. It is important to maintain a clear, professional boundary. It is also important to communicate regularly with any other health care professionals involved with the individual, including doctors, therapists, and service providers. The individual may be saying different things to different professionals.
Sometimes individuals with borderline disorder work very well in helping others who seem “worse off” than themselves. The caretaker role seems to be rewarding for them. This might include working in a retirement centre, working with individuals with mental retardation, working in a veterinary clinic, or working in an animal shelter.
Hope this helps.
MontyD
