Unit 9 Discussion

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What are Monica’s symptoms of Borderline Personality Disorder? Monica displayed several symptoms of borderline personality disorder in her first session with Lucero. The first symptom she described is inappropriate intense anger when she shared that she began to throw things out of her boyfriend’s car after an argument. She also displayed a pattern of unstable interpersonal relationships, characterized by idealization and devaluation (APA, 2022). At first, she mentioned that her boyfriend was perfect, good-looking, and was there for her and spending a lot of time together. Then, she described him, and all other men she dated, as jerks when they have a disagreement, and related this behavior to him not caring for her or being there for her. Monica also had evidence of impulsivity in risky behaviors, such as engaging in sexual relationships with men she doesn’t know and overspending when she is feeling intense emotional reactions. It can be said that Monica also displayed frantic efforts to avoid abandonment, whether real or imagined, in her interpersonal relationships by constantly seeking out her boyfriend and/or friends when she has feelings of emptiness and not wanting them to spend time with others who are not her. This was also exhibited towards the end of her session with Lucero, where she was refusing to allow the session to end and even offered Lucero money to extend the session. Monica also disclosed that she utilizes suicidal threats with her loved ones as a method to see if they truly care for her. Lastly, Monica displayed an unstable self-image. At the beginning of her session, she described having a lot to offer in a relationship by being pretty and fun. After additional probing from Lucero, Monica stated that in her moments of emptiness, she often questions whether she is good enough or pretty enough to be in a relationship, and if that is the reason why she always encounters relationship problems. How are Monica’s relationships affected by her BPD in terms of when she is happy with someone verses when she is disappointed by them? Monica’s relationships are affected by her BPD due to her intense emotional reactivity and exhibiting idealization and devaluation with the interpersonal relationships she discussed. When she is happy with someone in her life, she described wanting to spend a lot of time together and “being there for them”. Monica shared that she is always there for her friends when they are sad by taking them shopping and overall making sure that they are feeling better at the end of their time together. However, when she feels disappointed by the people in her life, she quickly begins devaluing them stating they don’t care about her, never have time for her, and are not there for her emotionally when she needs them. Monica has an expectation that the people in her life need to be there for her, as she feels she is there for them, to meet her needs on demand (APA, 2022). What are some events in Monica’s background that may have contributed to her condition of BPD? Monica stated that she has parents but was raised by her grandmother. She shared that her father was simply never around to parent her and that her mother could not raise her due to her substance abuse. She also stated that although her grandmother raised her, she felt as if she raised herself. These statements all point towards emotional neglect in her childhood, which has been found to be associated with borderline personality disorder (APA, 2022). There is also an increased familial risk for Monica to be diagnosed with borderline personality disorder due to her mother’s substance abuse (APA, 2022).

In your clinical opinion, what would be the most difficult symptom of BPD to manage in a session and why? How would you handle your reactions (countertransference) it if a client presented this way in a session? I believe a client’s lack of self-awareness would be the most difficult symptom to manage in session. As the video showed, Monica did not see any of her actions as problematic. She always found the other person in a disagreement to be the blame and the reason why the relationships in her life were hard. If a client presented this way in a session, I would continue asking probing questions in hopes of getting my client to gain some insight on her maladaptive behaviors. I would also present hypothetical situations with her reaction being different in these scenarios to see if she would look at the situations from a different standpoint. With a client of this nature, it is important to remain empathetic and learn when to pull back in session as to not make the client feel targeted or attacked as Monica did in the video, and so the client will continue feeling heard and understood. Using 1-2 scholarly sources, describe the most effective and well-known therapeutic modality for BPD: Dr. Marsha Linehan conducted the first randomized control trial for dialectical behavior therapy (DBT) in the early 1990s (Choi-Kain et al., 2017). DBT is based on cognitive-behavioral principles, and deals with the interaction of conflicting ideas, which means DBT calls for the acceptance of behavior and the change necessary to facilitate improvement in a client’s quality of life (May et al., 2016). DBT usually has 4 components: skills training group, individual psychotherapy, telephone consultation, and therapist consultation team (May et al., 2016). DBT aims to address client’s negative behaviors with healthy coping skills utilizing skills like mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance (May et al., 2016). References: American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A., & Unruh, B. T. (2017). What Works in the Treatment of Borderline Personality Disorder. Current behavioral neuroscience reports , 4 (1), 21–30. https://doi.org/10.1007/s40473-017-0103-z May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. The mental health clinician , 6 (2), 62–67. https://doi.org/10.9740/mhc.2016.03.62

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