Borderline Personality Disorder: A Clinical Guide

Voorkant
American Psychiatric Pub, 20 feb. 2009 - 366 pagina's

Covering the range of clinical presentations, treatments, and levels of care, Borderline Personality Disorder: A Clinical Guide, Second Edition, provides a comprehensive guide to the diagnosis and treatment of borderline personality disorder (BPD). The second edition includes new research about BPD's relationship to other disorders and up-to-date descriptions of empirically validated treatments, including cognitive-behavioral and psychodynamic approaches. Compelling new research also indicates a much better prognosis for BPD than previously known.

A pioneer in the field, author John Gunderson, M.D., director of the Borderline Personality Disorder Center at McLean Hospital, draws from nearly 40 years of research and clinical experience. The guide begins with a clear and specific definition of BPD, informed by a nuanced overview of the historical evolution of the diagnosis and a thoughtful discussion of misdiagnosis. Offering a complete evaluation of treatment approaches, Dr. Gunderson provides an authoritative overview of the treatment options and describes in-depth each modality of treatment, including pharmacotherapy, family therapy, individual and group therapy, and cognitive-behavioral therapies.

Unlike other works, this book guides clinicians in using multiple modalities, including the sequence of treatments and the types of changes that can be expected from each mode. The discussion of each treatment emphasizes empirically validated therapies, helping clinicians choose modalities that work best for specific patients. In addition, Borderline Personality Disorder: A Clinical Guide, Second Edition, also outlines therapeutic approaches for multiple settings, such as hospitalization, partial hospitalization or day hospital programs, and levels of outpatient care.

Complementing the well-organized treatment guide are a series of informative and intriguing sidebars, providing insight into the subjective experience of BPD, addressing myths about therapeutic alliances in BPD, and questioning the efficacy of contracting for safety. Throughout the book, Dr. Gunderson recommends specific do's and don'ts for disclosing the diagnosis, discussing medications, meeting with families, starting psychotherapy, and managing suicidality.

A synthesis of theory and practical examples, Borderline Personality Disorder: A Clinical Guide, Second Edition, provides a thorough and practical manual for any clinician working with BPD patients.

 

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Inhoudsopgave

THE BORDERLINE DIAGNOSIS
1
From Organization to Syndrome to Disorder
5
Epidemiology
9
Intolerance of Aloneness
18
Misuses of the Borderline Diagnosis
22
SelfInjurious Behavior
24
Use of the Diagnosis in Adolescents
27
Summary
28
Summary
169
References
170
FAMILY INTERVENTIONS AND THERAPIES
177
Therapists and Countertransferences
180
Overcoming Resistance
181
Initial Family Meetings
183
Establishing an Alliance
187
Psychoeducational Family Therapy
189

DIFFERENTIAL DIAGNOSIS Overlaps Subtleties and Treatment Implications
37
From Schizophrenia to Depression to Posttraumatic Stress Disorder to Bipolar Disorder
38
Comorbidity and Differential Diagnosis
40
Summary
59
References
60
OVERVIEW OF TREATMENT
65
Generic Therapeutic Processes and the Functions They Serve
67
An Overview
71
Sociotherapies
72
Changes Within Four Spheres Affects or Emotions
77
The Initial Structuring of Treatment
80
Types and Sequence of Therapeutic Alliance
82
Countertransference
84
Summary
85
CASE MANAGEMENT The Primary Clinician
89
Qualifications
90
Liability Issues
92
Relationship Management
93
Managing Safety
94
The Principle of False Submission
102
Implementing Changes
105
Boundaries Violations and Setting Limits
106
Splits Splitting and the Virtues of Split Treatments
107
Giving Receiving and Participating in Supervision
110
References
111
LEVELS OF CARE Indications Structure Staffing
113
Selecting or Changing a Level of Care
114
Hospital TreatmentMakes Therapy Possible
115
ResidentialPartial Hospital CareDay Treatment Basic Socialization
122
Intensive Outpatient CareBehavioral Change
130
Outpatient CareInterpersonal Growth
133
Summary
134
References
135
PHARMACOTHERAPY Clinical Practices
139
Overall Role of Medications
140
Getting Started
143
Symptom Chasing
148
TransferenceCountertransference Issues
149
Contraindications and Discontinuance
151
Summary
153
PHARMACOTHERAPY Selection of Medications
157
The SymptomTargeted Model
158
Psychodynamic Family Therapy
196
Marital or Couples Therapy Initial Meetings
197
Summary
201
GROUP THERAPY
207
Engaging Patients and the Primary Clinicians Role
208
Skills Training Groups
209
Psychodynamic Group Therapies Interpersonal Group Psychotherapy
214
Group Structure
216
Common Problems
218
Summary
222
INDIVIDUAL PSYCHOTHERAPIES Getting Started
225
Getting Started
227
Structuring the Therapeutic Frame External Boundaries
231
Therapists Qualifications
236
Engagement
243
Generic Qualities of Effective Psychotherapies
247
Summary
250
COGNITIVEBEHAVIORAL THERAPIES Dialectical Behavior Therapy and Cognitive Therapies
253
Basic Operant Conditioning Applications for All Treatment Settings
255
Dialectical Behavior Therapy
256
Cognitive Therapies
267
Summary
274
PSYCHODYNAMIC PSYCHOTHERAPIES
279
PreEmpirical Developments
280
Nonrandomized Trials
282
TransferenceFocused Psychotherapy
286
Overview of Change Processes
289
A Relational Alliance
291
Positive Dependency
298
Secure Attachment the Working Alliance and Consolidation of Self
304
Impasses
305
Summary
307
FUTURE CONSIDERATIONS
315
Diagnostic Implications
318
Public Awareness and Advocacy
321
Summary
324
References
325
PSYCHOEDUCATIONAL RESOURCES PRINTED MATERIALS VIDEOS FILMS AND WEB SITES
329
Videos
331
Web Sites
332
INDEX
337
Copyright

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Over de auteur (2009)

John G. Gunderson, M.D., is Professor of Psychiatry at Harvard Medical School in Boston, Massachusetts; Director of Psychosocial and Personality Research and Director of the Borderline Personality Disorder Center at McLean Hospital in Belmont, Massachusetts.

Paul S. Links, M.D., F.R.C.P.C., is Professor of Psychiatry at the University of Toronto, Toronto, Canada.

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