Borderline Personality Disorder: A Clinical GuideCovering 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
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 |
331 | |
Web Sites | 332 |
337 | |
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Borderline Personality Disorder: A Clinical Guide John G. Gunderson,Paul S. Links Geen voorbeeld beschikbaar - 2008 |