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Systemic Treatment of BPD


Dustin Tibbitts

on 4 February 2014

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Transcript of Systemic Treatment of BPD

Systemic Treatment of BPD
Goldstein and Jones have categorized
FOUR GROUPS of BPD adolescents
based on systemic behavioral manifestations
At least three of the criteria for BPD in the DSM IV (8) directly pertain to interpersonal relationships:
1. efforts to avoid abandonment,
2. unstable and intense interpersonal relationships, and
3. inappropriate, intense anger or difficulty controlling anger.
1. Childhood Trauma
2. Early parental separation and loss
3. Disturbed family environment and abnormal parental bonding (Paris, 1994, 1999; Zanarini & Frankenburg, 1997).
Oscillations of Attachment
Object Constancy
identify the countertransference: 4 parts
experiential activity to highlight triangles
parallel process
countertransference training
button pushing response (worksheet)
personal scrutiny (worksheet)
shorten session; longer wrap-up
Attachment group, DBT group
Linehan: give her your phone number
Cummings' emergency policy
Routine shifts of groups of staff
Clarification skills
validate emotion yet hold accountable
remain in here-and-now
avoid misappropriating responsibility
Rick Biesinger, Psy.D., InnerChange and Dustin Tibbitts, LMFT, New Haven
needs vs. wants
compromise (negotiation) skills
"Benevolent Disengagement"
Clarify "non-negotiables"
Kernberg's "Pilot's List" of priorities
assign one staff per shift to be primary contact
Normal Personality Organization
I. Healthy Relationships
2. Stable Identity
Relationship "check-in" every session (SRS)
Thanks for Attending!
Allow strategic phone contact
Allow strategic visits
frequency, activities, neutral ground
Word choice and metaphor
Email rule
Treatment Team attendance
Challenge inconsistencies across contexts
Affect identification/management
Parallel journaling
Identity Worksheets
Share progress or case notes
Values prioritization
Core issue work in front of child
childhood pics
extended family histories
Full transcript