Dialectical Dilemmas
(Turn into secondary behavioral targets)
- emotional vulnerability vs. self invalidation
- active passivity vs. apparent competence
- unrelenting crisis vs. inhibited grieving
PreTreatement: Orienting, Biosocial Model Education, Commitment to:
1. decrease suicidal behaviors and parasuicidal behaviors
2. decrease therapy interfering behaviors
3. increase behavioral skills
Stages of Treatment
1. Stage 1
- decreasing suicidal behaviors
-decreasing therapy interfering behaviors
-decreasing QOL interfering behaviors
- Increasing behavioral skills
2. Stage 2
- Decreasing PTSD behaviors
3. Stage 3
- Increasing self respect and achieving goals
Behavioral Skills
1. Mindfulness
2. Distress Tolerance
3. Emotion Regulation
4. Interpersonal Effectiveness
5. Self Management
Assumptions about BPDs and Treatment
- Patients are doing the best they can
- Patients want to improve
- Patients need to do better, try harder
- Patients may not have caused problems but have to solve them anyway
- lives of patients are unbearable
- patients need to learn new behaviors in all context
- patients cannot fail therapy
-therapist need support
Therapist Consultation Agreements
- Dialectical
- Consultation to the patient
-Inconsistency: goal of therapy is not to make a perfect, consistent world
- observing limits
-phenomenological empathy
-fallibility
Basic Treatment Strategies