An edition of Cognitive-behavioral treatment of borderline personality disorder (1993)

Cognitive-behavioral treatment of borderline personality disorder

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An edition of Cognitive-behavioral treatment of borderline personality disorder (1993)

Cognitive-behavioral treatment of borderline personality disorder

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  • 20 Want to read
  • 1 Currently reading

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Publish Date
Publisher
Guilford Press
Language
English
Pages
558

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Subjects

Behavior therapy Borderline personality disorder Cognitive therapy Therapy Treatment Mentally ill, care Cognitive Behavioral Therapy État-limite (Psychiatrie) Traitement Thérapie cognitive PSYCHOLOGY Mental Illness Borderline-Persönlichkeitsstörung Kognitive Psychotherapie Kognitive Verhaltenstherapie Borderline persoonlijkheid Cognitieve therapie Borderline personality disorder--treatment Borderline personality disorder--therapy Rc569.5.b67 l56 1993 Wm 190 l754c 1993 616.85/8520651
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Cover of: Cognitive-behavioral treatment of borderline personality disorder
Cognitive-behavioral treatment of borderline personality disorder
1993, Guilford Press
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Table of Contents

Part I. Theory and Concepts
1. Borderline Personality Disorder: Concepts, Controversies, and Definitions
Page 3
The Concept of Borderline Personality Disorder
Page 5
The Concept of Parasuicidal Behaviors
Page 13
The Overlap Between Borderline Personality Disorder and Parasuicidal Behavior
Page 15
Therapy for Borderline Personality Disorder: A Preview
Page 19
Concluding Comments
Page 25
Notes
Page 26
2. Dialectical and Biosocial Underpinnings of Treatment
Page 28
Dialectics
Page 28
Borderline Personality Disorder as Dialectical Failure
Page 35
Case Conceptualization: A Dialectical Cognitive-Behavioral Approach
Page 37
Biosocial Theory: A Dialectical Theory of Borderline Personality Disorder Development
Page 42
Implications of the Biosocial Theory for Therapy with Borderline Patients
Page 62
Concluding Comments
Page 64
Notes
Page 65
3. Behavioral Patterns: Dialectical Dilemmas in the Treatment of Borderline Patients
Page 66
Emotional Vulnerability versus Self-Invalidation
Page 67
Active Passivity versus Apparent Competence
Page 78
Unrelenting Crises versus Inhibited Grieving
Page 85
Concluding Comments
Page 93
Notes
Page 94
Part II. Treatment Overview and Goals
4. Overview of Treatment: Targets, Strategies, and Assumptions in a Nutshell
Page 97
Crucial Steps in Treatment
Page 97
Setting the Stage: Getting the Patient's Attention
Page 97
Staying Dialectical
Page 98
Applying Core Strategies: Validation and Problem Solving
Page 99
Balancing Interpersonal Communication Styles
Page 100
Combining Consultation-to-the-Patient Strategies with Interventions in the Environment
Page 101
Treating the Therapist
Page 101
Modes of Treatment
Page 101
Individual Outpatient Psychotherapy
Page 102
Skills Training
Page 103
Supportive Process Group Therapy
Page 103
Telephone Consultation
Page 104
Case Consultation Meetings for Therapists
Page 104
Ancillary Treatments
Page 105
Assumptions About Borderline Patients and Therapy
Page 106
1. Patients Are Doing the Best They Can
Page 106
2. Patients Want to Improve
Page 106
3. Patients Need to Do Better, Try Harder, and Be More Motivated to Change
Page 106
4. Patients May Not Have Caused All of Their Own Problems, but They Have to Solve Them Anyway
Page 107
5. The Lives of Suicidal, Borderline Individuals Are Unbearable as They Are Currently Being Lived
Page 107
6. Patients Must Learn New Behaviors in All Relevant Contexts
Page 107
7. Patients Cannot Fail in Therapy
Page 108
8. Therapists Treating Borderline Patients Need Support
Page 108
Therapist Characteristics and Skills
Page 108
Stance of Acceptance versus Change
Page 109
Stance of Unwavering Centeredness versus Compassionate Flexibility
Page 110
Stance of Nurturing versus Benevolent Demanding
Page 111
Agreements of Patients and Therapists
Page 112
Patient Agreements
Page 112
Therapist Agreements
Page 115
Therapist Consultation Agreements
Page 117
Dialectical Agreement
Page 117
Consultation-to-the-Patient Agreement
Page 117
Consistency Agreement
Page 117
Observing-Limits Agreement
Page 118
Phenomenological Empathy Agreement
Page 118
Fallibility Agreement
Page 118
Concluding Comments
Page 119
Note
Page 119
5. Behavioral Targets in Treatment: Behaviors to Increase and Decrease
Page 120
The Overall Goal: Increasing Dialectical Behavior Patterns
Page 120
Dialectical Thinking
Page 120
Dialectical Thinking and Cognitive Therapy
Page 123
Dialectical Behavior Patterns: Balanced Lifestyle
Page 124
Primary Behavioral Targets
Page 124
Decreasing Suicidal Behaviors
Page 124
Decreasing Therapy-Interfering Behaviors
Page 129
Decreasing Behaviors That Interfere with Quality of Life
Page 141
Increasing Behavioral Skills
Page 143
Decreasing Behaviors Related to Posttraumatic Stress
Page 155
Increasing Respect for Self
Page 160
Secondary Behavioral Targets
Page 160
Increasing Emotion Modulation; Decreasing Emotional Reactivity
Page 161
Increasing Self-Validation; Decreasing Self-Invalidation
Page 161
Increasing Realistic Decision Making and Judgment; Decreasing Crisis-Generating Behaviors
Page 162
Increasing Emotional Experiencing; Decreasing Inhibited Grieving
Page 162
Increasing Active Problem Solving; Decreasing Active-Passivity Behaviors
Page 162
Increasing Accurate Communication of Emotions and Competencies; Decreasing Mood Dependency of Behavior
Page 163
Concluding Comments
Page 164
Note
Page 164
6. Structuring Treatment Around Target Behaviors: Who Treats What and When
Page 165
The General Theme: Targeting Dialectical Behaviors
Page 166
The Hierarchy of Primary Targets
Page 166
Treatment Targets and Session Agenda
Page 167
Treatment Targets and Modes of Therapy
Page 167
The Primary Therapist and Responsibility for Meeting Targets
Page 168
Progress Toward Targets Over Time
Page 168
Pretreatment Stage: Orientation and Commitment
Page 169
Stage 1: Attaining Basic Capacities
Page 169
Stage 2: Reducing Posttraumatic Stress
Page 170
Stage 3: Increasing Self-Respect and Achieving Individual Goals
Page 172
Setting Priorities within Target Classes in Outpatient Individual Therapy
Page 173
Decreasing Suicidal Behaviors
Page 174
Decreasing Therapy-Interfering Behaviors
Page 175
Decreasing Quality-of-Life-Interfering Behaviors
Page 177
Increasing Behavioral Skills
Page 178
Reducing Posttraumatic Stress
Page 179
Increasing Self-Respect and Achieving Individual Goals
Page 179
Using Target Priorities to Organize Sessions
Page 180
Patient and Therapist Resistance to Discussing Target Behaviors
Page 181
Individual Therapy Targets and Diary Cards
Page 184
Skills Training: Hierarchy of Targets
Page 186
Supportive Process Groups: Hierarchy of Targets
Page 187
Telephone Calls: Hierarchy of Targets
Page 188
Calls to the Primary Therapist
Page 188
Calls to Skills Trainers and Other Therapists
Page 190
Target Behaviors and Session Focus: Who Is in Control?
Page 190
Modification of Target Hierarchies in Other Settings
Page 191
Responsibility for Decreasing Suicidal Behaviors
Page 192
Responsibility for Other Targets
Page 193
Specifying Targets for Other Modes of Treatment
Page 193
Turf Conflicts with Respect to Target Responsibilities
Page 194
Concluding Comments
Page 195
Part III. Basic Treatment Strategies
7. Dialectical Treatment Strategies
Page 199
Defining Dialectical Strategies
Page 201
Balancing Treatment Strategies: Dialectics of the Therapeutic Relationship
Page 202
Teaching Dialectical Behavior Patterns
Page 204
Specific Dialectical Strategies
Page 205
1. Entering the Paradox
Page 205
2. The Use of Metaphor
Page 209
3. The Devil's Advocate Technique
Page 212
4. Extending
Page 213
5. Activating 'Wise Mind'
Page 214
6. Making Lemonade Out of Lemons
Page 216
7. Allowing Natural Change
Page 217
8. Dialectical Assessment
Page 218
Concluding Comments
Page 219
Notes
Page 220
8. Core Strategies: Part I. Validation
Page 221
Defining Validation
Page 222
Why Validate?
Page 225
Emotional Validation Strategies
Page 226
1. Providing Opportunities for Emotional Expression
Page 228
2. Teaching Emotion Observation and Labeling Skills
Page 230
3. Reading Emotions
Page 231
4. Communicating the Validity of Emotions
Page 234
Behavioral Validation Strategies
Page 235
1. Teaching Behavior Observation and Labeling Skills
Page 235
2. Identifying the 'Should'
Page 237
3. Countering the 'Should'
Page 237
4. Accepting the 'Should'
Page 238
5. Moving to Disappointment
Page 239
Cognitive Validation Strategies
Page 239
1. Eliciting and Reflecting Thoughts and Assumptions
Page 240
2. Discriminating Facts from Interpretations
Page 240
3. Finding the 'Kernel of Truth'
Page 241
4. Acknowledging 'Wise Mind'
Page 242
5. Respecting Differing Values
Page 242
Cheerleading Strategies
Page 242
1. Assuming the Best
Page 244
2. Providing Encouragement
Page 245
3. Focusing on the Patient's Capabilities
Page 246
4. Contradicting/Modulating External Criticism
Page 247
5. Providing Praise and Reassurance
Page 247
6. Being Realistic, but Dealing Directly with Fears of Insincerity
Page 248
7. Staying Near
Page 249
Concluding Comments
Page 249
9. Core Strategies: Part II. Problem Solving
Page 250
Levels of Problem Solving
Page 250
First Level
Page 250
Second Level
Page 250
Third Level
Page 251
Mood and Problem Solving
Page 251
Overview of Problem-Solving Strategies
Page 253
Behavioral Analysis Strategies
Page 254
1. Defining the Problem Behavior
Page 255
2. Conducting a Chain Analysis
Page 258
3. Generating Hypotheses about Factors Controlling Behavior
Page 264
Insight (Interpretation) Strategies
Page 265
What and How to Interpret: Guidelines for Insight
Page 266
1. Highlighting
Page 270
2. Observing and Describing Recurrent Patterns
Page 271
3. Commenting on Implications of Behavior
Page 271
4. Assessing Difficulties in Accepting or Rejecting Hypotheses
Page 271
Didactic Strategies
Page 272
1. Providing Information
Page 273
2. Giving Reading Materials
Page 274
3. Giving Information to Family Members
Page 274
Solution Analysis Strategies
Page 275
1. Identifying Goals, Needs, and Desires
Page 276
2. Generating Solutions
Page 278
3. Evaluating Solutions
Page 279
4. Choosing a Solution to Implement
Page 281
5. Troubleshooting the Solution
Page 281
Orienting Strategies
Page 281
1. Providing Role Induction
Page 282
2. Rehearsing New Expectations
Page 283
Commitment Strategies
Page 284
Levels of Commitment
Page 284
Commitment and Recommitment
Page 285
The Need for Flexibility
Page 286
1. Selling Commitment: Evaluating the Pros and Cons
Page 286
2. Playing the Devil's Advocate
Page 286
3. 'Foot-in-the-Door' and 'Door-in-the-Face' Techniques
Page 288
4. Connecting Present Commitments to Prior Commitments
Page 289
5. Highlighting Freedom to Choose and Absence of Alternatives
Page 289
6. Using Principles of Shaping
Page 290
7. Generating Hope: Cheerleading
Page 290
8. Agreeing on Homework
Page 291
Concluding Comments
Page 291
10. Change Procedures: Part I. Contingency Procedures (Managing Contingencies and Observing Limits)
Page 292
The Rationale for Contingency Procedures
Page 294
The Distinction Between Managing Contingencies and Observing Limits
Page 295
The Therapeutic Relationship as Contingency
Page 296
Contingency Management Procedures
Page 297
Orienting to Contingency Management: Task Overview
Page 297
1. Reinforcing Target-Relevant Adaptive Behaviors
Page 301
2. Extinguishing Target-Relevant Maladaptive Behaviors
Page 302
3. Using Aversive Consequences ... with Care
Page 306
Determining the Potency of Consequences
Page 314
Using Natural Over Arbitrary Consequences
Page 317
Principles of Shaping
Page 318
Observing-Limits Procedures
Page 319
Rationale for Observing Limits
Page 320
Natural versus Arbitrary Limits
Page 321
1. Monitoring Limits
Page 322
2. Being Honest About Limits
Page 323
3. Temporarily Extending Limits When Needed
Page 325
4. Being Consistently Firm
Page 325
5. Combining Soothing, Validating, and Problem Solving with Observing Limits
Page 326
Difficult Areas for Observing Limits with Borderline Patients
Page 326
Concluding Comments
Page 327
11. Change Procedures: Part II. Skills Training, Exposure, Cognitive Modification
Page 329
Skills Training Procedures
Page 329
Orienting and Committing to Skills Training: Task Overview
Page 330
Skill Acquisition Procedures
Page 331
Skill Strengthening Procedures
Page 334
Skill Generalization Procedures
Page 337
Exposure-Based Procedures
Page 343
Orienting and Commitment to Exposure: Task Overview
Page 345
1. Providing Nonreinforced Exposure
Page 347
2. Blocking Action Tendencies Associated with Problem Emotions
Page 354
3. Blocking Expressive Tendencies Associated with Problem Emotions
Page 356
4. Enhancing Control Over Aversive Events
Page 357
Structured Exposure Procedures
Page 358
Cognitive Modification Procedures
Page 358
Orienting to Cognitive Modification Procedures
Page 360
Contingency Clarification Procedures
Page 361
Cognitive Restructuring Procedures
Page 364
Concluding Comments
Page 370
Note
Page 370
12. Stylistic Strategies: Balancing Communication
Page 372
Reciprocal Communication Strategies
Page 372
Power and Psychotherapy: Who Makes the Rules?
Page 372
1. Responsiveness
Page 373
2. Self-Disclosure
Page 376
3. Warm Engagement
Page 383
4. Genuineness
Page 388
The Need for Therapist Invulnerability
Page 390
Irreverent Communication Strategies
Page 393
Dialectical Strategies and Irreverence
Page 393
1. Reframing in an Unorthodox Manner
Page 394
2. Plunging in Where Angels Fear to Tread
Page 395
3. Using a Confrontational Tone
Page 396
4. Calling the Patient's Bluff
Page 396
5. Oscillating Intensity and Using Silence
Page 396
6. Expressing Omnipotence and Impotence
Page 397
Concluding Comments
Page 397
Note
Page 398
13. Case Management Strategies: Interacting with the Community
Page 399
Environmental Intervention Strategies
Page 401
Case Management and Observing Limits
Page 401
1. Providing Information Independently of the Patient
Page 404
2. Patient Advocacy
Page 404
3. Entering the Patient's Environment to Give Her Assistance
Page 405
Consultation-to-the-Patient Strategies
Page 406
Rationale and Spirit of Consultation to the Patient
Page 407
The 'Treatment Team' versus 'Everyone Else'
Page 408
1. Orienting the Patient and the Network to the Approach
Page 409
2. Consultation to the Patient about How to Manage Other Professionals
Page 411
3. Consultation to the Patient about How to Handle Family and Friends
Page 419
Arguments Against the Consultation Approach
Page 421
Therapist Supervision/Consultation Strategies
Page 423
The Need for Supervision/Consultation
Page 424
1. Meeting to Confer on Treatment
Page 426
2. Keeping Supervision/Consultation Agreements
Page 428
3. Cheerleading
Page 429
4. Providing Dialectical Balance
Page 430
Working Out Problems of 'Staff Splitting'
Page 431
Dealing with Unethical or Destructive Therapist Behavior
Page 433
Keeping Information Confidential
Page 434
Concluding Comments
Page 434
Part IV. Strategies for Specific Tasks
14. Structural Strategies
Page 437
Contracting Strategies: Starting Treatment
Page 438
1. Conducting a Diagnostic Assessment
Page 438
2. Presenting the Biosocial Theory of Borderline Behavior
Page 440
3. Orienting the Patient to Treatment
Page 442
4. Orienting the Network to Treatment
Page 443
5. Reviewing Treatment Agreements and Limits
Page 444
6. Committing to Therapy
Page 444
7. Conducting Analyses of Major Target Behaviors
Page 446
8. Beginning to Develop the Therapeutic Relationship
Page 446
Caveats in the Real World
Page 447
Session-Beginning Strategies
Page 448
1. Greeting the Patient
Page 449
2. Recognizing the Patient's Current Emotional State
Page 449
3. Repairing the Relationship
Page 450
Targeting Strategies
Page 450
1. Reviewing Target Behaviors Since the Last Session
Page 452
2. Using Target Priorities to Organize Sessions
Page 453
3. Attending to Stages of Therapy
Page 453
4. Checking Progress in Other Modes of Therapy
Page 453
Session-Ending Strategies
Page 454
1. Providing Sufficient Time for Closure
Page 454
2. Agreeing on Homework for the Coming Week
Page 454
3. Summarizing the Session
Page 455
4. Giving the Patient a Tape of the Session
Page 455
5. Cheerleading
Page 456
6. Soothing and Reassuring the Patient
Page 456
7. Troubleshooting
Page 457
8. Developing Ending Rituals
Page 457
Terminating Strategies
Page 457
1. Beginning Discussion of Terminating: Tapering Off Sessions
Page 457
2. Generalizing Interpersonal Reliance to the Social Network
Page 458
3. Actively Planning for Termination
Page 459
4. Making Appropriate Referrals
Page 460
Concluding Comments
Page 461
15. Special Treatment Strategies
Page 462
Crisis Strategies
Page 462
1. Paying Attention to Affect Rather Than Content
Page 463
2. Exploring the Problem Now
Page 463
3. Focusing on Problem Solving
Page 465
4. Focusing on Affect Tolerance
Page 467
5. Obtaining Commitment to a Plan of Action
Page 468
6. Assessing Suicide Potential
Page 468
7. Anticipating a Recurrence of the Crisis Response
Page 468
Suicidal Behavior Strategies
Page 468
The Therapeutic Task
Page 469
Previous Suicidal Behaviors: Protocol for the Primary Therapist
Page 469
Threats of Imminent Suicide or Parasuicide: Protocol for the Primary Therapist
Page 476
Ongoing Parasuicidal Act: Protocol for the Primary Therapist
Page 490
Suicidal Behaviors: Protocol for Collateral Therapists
Page 492
Principles of Risk Management with Suicidal Patients
Page 493
Therapy-Interfering Behavior Strategies
Page 495
1. Defining the Interfering Behavior
Page 495
2. Conducting a Chain Analysis of the Behavior
Page 495
3. Adopting a Problem-Solving Plan
Page 496
4. Responding to the Patient Who Refuses to Modify Interfering Behavior
Page 497
Telephone Strategies
Page 497
1. Accepting Patient-Initiated Phone Calls Under Certain Conditions
Page 498
2. Scheduling Patient-Initiated Phone Calls
Page 502
3. Initiating Therapist Phone Contacts
Page 502
4. Giving Feedback About Phone Call Behavior During Sessions
Page 502
Therapist Availability and Management of Suicidal Risk
Page 503
Ancillary Treatment Strategies
Page 504
1. Recommending Ancillary Treatment When Needed
Page 504
2. Recommending Outside Consultation for the Patient
Page 505
Medication Protocol
Page 507
Hospital Protocol
Page 510
Relationship Strategies
Page 514
1. Relationship Acceptance
Page 515
2. Relationship Problem Solving
Page 517
3. Relationship Generalization
Page 519
Concluding Comments
Page 519
Appendix 15.1. Scale Points for Lethality Assessment
Page 519
Note
Page 523
Appendix: Suggested Reading
Page 524
References
Page 527
Index
Page 547

Edition Notes

Includes bibliographical references (p. 527-546) and index.

Published in
New York
Series
Diagnosis and treatment of mental disorders

Classifications

Dewey Decimal Class
616.85/8520651
Library of Congress
RC569.5.B67 L56 1993, RC569.5.B67L56 1993, RC569.5.B67 L56 1993eb

The Physical Object

Pagination
xvii, 558 p. :
Number of pages
558

Edition Identifiers

Open Library
OL1411643M
ISBN 10
0898621836
LCCN
93020483
OCLC/WorldCat
213444085, 27854187
LibraryThing
35416
Goodreads
421520

Work Identifiers

Work ID
OL3919115W

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