Intervention In Borderline Personality Disorder

Typical of borderline personality disorder is the tendency to an emotional escalation in situations that generate frustration or malaise. What are the possible interventions?
Intervention in borderline personality disorder

The intervention in borderline personality disorder takes into account a typical characteristic of the patient : when faced with a situation that generates frustration or suffering, the response is non-adaptive behavior. This reaction is linked to too high expectations which, if not met, end up generating discomfort.

In this disorder, dichotomous thinking is equally frequent, which conditions social relationships and the perception of reality. This would explain, on the other hand, a rigid behavior that limits the emotional, work and social sphere.

It is true that emotionally stable people can react equally inappropriately in situations that generate frustration. However, there is a clear difference between someone who enjoys emotional stability and a borderline personality disorder individual.

The former usually know to what extent they can “get carried away” by emotions. The latter, on the contrary, react intensely to the malaise, going so far as to implement risky behaviors.

Woman in the mirror with hands on her face.

Borderline Personality Disorder

Borderline Personality Disorder is classified in the DSMV within cluster B of personality disorders. It is characterized by a pattern of emotional instability that conditions social relationships, the image one has of oneself and the affections.

Impulsivity is another typical trait that manifests itself, in an emotional escalation, as a reaction to unpleasant events. At worst, it can lead to dangerous behaviors such as self-harm or aggression.

We can broadly summarize the mechanism of borderline personality disorder with the tendency to a rather strong emotional escalation in the face of situations capable of generating unpleasant emotions. This progressive intensification of emotions is a sign of a high reactivity to the environment, with a slower than normal return to the basal line.

Intervention in borderline personality disorder

Borderline Personality Disorder is often associated with other disorders (eating, impulse control and addictions). Psychological therapy is necessary and important throughout the duration of treatment.

The non-adaptive behaviors associated with this disorder help to calm the discomfort only in the short term, but not in the long term. Medicines, in this sense, can be a good complement to psychotherapy.

In some cases, hospitalization or specific treatment of associated disorders is required. Two possible modes of intervention in borderline personality disorder are described below .

Dialectical Behavioral Therapy

Developed by Marsha Linehan, it  combines behavioral strategies with acceptance and change strategies through a dialectical model.

The dialectic, part of the therapeutic program, exaggerates the absolutist conclusions of dichotomous thinking; it stimulates the acceptance of malaise and the modification of some dysfunctional behavioral patterns.

What does the treatment consist of?

Standard Dialectical Behavioral Therapy for Borderline Personality Disorder Treatment is a comprehensive program involving four approaches:

  • Individual therapy. The sessions generally have a weekly frequency and a duration of 50-60 minutes.
  • Skill Enhancement. This module, performed in a group and led by another therapist, completes the individual therapy. The skills exercised are awareness, emotional regulation, tolerance to discomfort and interpersonal effectiveness. The sessions are weekly and last 2-3 hours.
  • Extension of skills. The patient must apply the skills acquired during group therapy to his daily context. To achieve this goal, telephone calls are made between sessions.
  • Control groups. With the intent to prevent burnout of the therapist in charge of the treatment, weekly supervision sessions are held with the entire work group.

Before accessing the therapeutic program, the patient undertakes to attend the sessions for the established time (generally from 6 to 12 months). Absence from four consecutive sessions is usually a reason for discontinuation of therapy. At the end of the period established by the therapeutic contract, it will be possible to negotiate a new entry into therapy.

Intervention in borderline personality disorder.

Therapy with symbolic images

Conceived by Spanish psychologist Soledad Santiago López, symbolic image therapy ( icónica therapy ) is an integrated model. It includes an explanatory phase, aimed at explaining the lack of emotional regulation; in addition, a therapeutic model that offers useful strategies for working on maladaptive behaviors and aspects of vulnerability that increase the risk of unstable behavior.

Features and application

This therapeutic approach treats borderline personality disorder through the use of symbolic images. The aim is to help verbalize, in a non-critical way, some aspects of maladaptive behavior.

Likewise, it fosters insight, allows you to exercise personal skills such as frustration tolerance and acceptance. It also works on aspects such as the feeling of emptiness, personal identity, self-esteem, etc.

The intervention involves the use of 32 images to be placed on a map. The map allows the patient to orient himself among the emotions, from the most negative ones to the most useful coping strategy. The treatment lasts about 12 weeks, accompanied, once a week, by group or family and individual sessions.

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