Borderline patient

[Childdoconeday]

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Overall I am very good at separating work from home life...but I am working with a kid and a parent who has significant borderline traits. I am finding myself feeling stressed about seeing them and find myself replaying what I want to say to the parent in session. Anyone experience this before? I imagine I’m not alone ? Any tips or words of advice with how to reduce the anxiety?

 

[deleted836592]

Supervision.

 

[Childdoconeday]

Supervision.

I don’t have any at my current site... maybe I need to find some

 

[Fan_of_Meehl]

Who's the client? (the kid?)

 

[cara susanna]

So this may be hard if you aren't trained in DBT, but the most effective approach is to balance change with validation. Don't be afraid to walk on the egg shells - gently tread on them with meaning and purpose. From my experience, most intense displays of emotion (read, anger) from someone with BPD in session are generally from the person not feeling heard or validated. So, if all else fails, ramp up the validation until the person is regulated enough to hear what you need to say.

Also, no, you are not alone. This is why DBT requires a consultation team. I would recommend seeking out consultation with a colleague, even if it's just to process or seek validation for yourself.

 

[DynamicDidactic]

Don't think of people by their diagnostic category. I understand the heuristic advantage but in the long run it wont help to view the parent as a "borderline". Instead find a way to empathize with the behaviors of the parent and put yourself in their shoes. For anyone that has worked with similar individuals, the feelings of anxiety about even having session is totally understandable. Having a team to help you can be very helpful. What about the sessions is anxiety-provoking? Once you figure that out you can try to problem-solve (or accept).

If you haven't, get some DBT training (as stated before).

 

[Fan_of_Meehl]

So this may be hard if you aren't trained in DBT, but the most effective approach is to balance change with validation. Don't be afraid to walk on the egg shells - gently tread on them with meaning and purpose. From my experience, most intense displays of emotion (read, anger) from someone with BPD in session are generally from the person not feeling heard or validated. So, if all else fails, ramp up the validation until the person is regulated enough to hear what you need to say.

Also, no, you are not alone. This is why DBT requires a consultation team. I would recommend seeking out consultation with a colleague, even if it's just to process or seek validation for yourself.

Absolutely. Working with clients who have BPD is challenging and Linehan's stuff is awesome. Conceptually, I find utility in her stuff all the time even working with non-BPD folks. The importance of prioritizing therapy-interfering behaviors (in particular) and the 'active passivity vs. apparent competence' dialectec spring immediately to mind. And her workbooks are practical, modular, and useful.

 

[Mindfulpsych22]

The another useful lesson from DBT- orienting. I think it is so easy for parents to feel judged or blamed when their kids isn’t doing well and even well-intentioned gentle suggestions from therapists can be interpreted that the parent is “doing something wrong” and is a bad parent. It can help to do really thorough empathizing and orientaing around the difficulty of raising a child who has emotional or behavioral struggles and your desire to support her through this and clarify the important role that you see her being able to play in the child’s improvement and what that may look like. This may make the spirit of your time together more collaborative and thus reduce your anxiety.

 

[Childdoconeday]

Who's the client? (the kid?)

Yes child is the client

 

[Fan_of_Meehl]

Overall I am very good at separating work from home life...but I am working with a kid and a parent who has significant borderline traits. I am finding myself feeling stressed about seeing them and find myself replaying what I want to say to the parent in session. Anyone experience this before? I imagine I’m not alone ? Any tips or words of advice with how to reduce the anxiety?

This might sound weird but I'd also (as I often do) even utilize elements of Linehan's philosophy on myself (e.g., mindfulness, radical acceptance, etc.). It helps calm MY emotional reactivity which can be an issue working with clients whose pathology tends to create 'drama' or emotional tension within the context of the therapy relationship. An added side-benefit is that if I am using Linehan's DBT principles/worksheets on myself, I learn them and can teach them better to the client if/when they are receptive.