Empathy for Cluster B patients

[OldPsychDoc]

I agree that in most cases as a psychiatrist you won't be the coast guard towing them back to shore (except maybe in NYC and Boston).

But I do think there is value in telling the person that they are in the Pacific Ocean and that they're drowning, if only so that when they coast guard comes they accept the help rather than chasing them away.

And even as a psychiatrist doing meds, there is value in being an empathetic and consistent presence in their lives. Going with the analogy, you can help the person by teaching them how to tread water while waiting for the coast guard to come.

And throw them a flotation device or two. Maybe some shark repellent.

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[vistaril]

But I do think there is value in telling the person that they are in the Pacific Ocean and that they're drowning, if only so that when they coast guard comes they accept the help rather than chasing them away.
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Well sure I guess.....although they have likely been told that many times before(even if they say they haven't). And that's the approach I take. My point was I'm not going to take credit for something(in the event the borderline makes progress eventually) for something in which my role was relatively minor in compared to the people doing the real lifting.

 

[smalltownpsych]

Well sure I guess.....although they have likely been told that many times before(even if they say they haven't). And that's the approach I take. My point was I'm not going to take credit for something(in the event the borderline makes progress eventually) for something in which my role was relatively minor in compared to the people doing the real lifting.

Sometimes it works better when the psychiatrist is the bad object. A good idealizing transference makes it easier to develop a solid relationship and connection before the bubble bursts and they begin devaluing me. Seriously though, I have been referred several patients with borderline personality recently who wanted to keep doing "therapy" with the NP who prescribes and I can't break through their initial hostility and feelings of abandonment from the referring provider. Any advice I could give the NP to make for a better hand-off would be helpful. Keep in mind that this NP does not do any psychotherapy and is clear about that, but is very good at developing rapport.

 

[vistaril]

Sometimes it works better when the psychiatrist is the bad object. A good idealizing transference makes it easier to develop a solid relationship and connection before the bubble bursts and they begin devaluing me. Seriously though, I have been referred several patients with borderline personality recently who wanted to keep doing "therapy" with the NP who prescribes and I can't break through their initial hostility and feelings of abandonment from the referring provider. Any advice I could give the NP to make for a better hand-off would be helpful. Keep in mind that this NP does not do any psychotherapy and is clear about that, but is very good at developing rapport.

I'm excellent at developing rapport with borderlines on inpatient services and they really like me. Probably just like they do this prescribing NP. but I'm not helping them longterm, or really 'fixing' anything.....and that's what Im getting at.

I definitely won't shy away from taking credit when I do something good or help a patient.......but all the positive encounters I have with borderlines(corrective emotional experiences if you will) doesn't really amount to much net gain. I'm not a difference maker for them.

You guys get the credit here. Now we do often get the blame, as many psychiatrists(myself included sometimes) prescribe toxic meds that won't help the patient. At least I try to limit this to some degree.

 

[notdeadyet]

My point was I'm not going to take credit for something(in the event the borderline makes progress eventually) for something in which my role was relatively minor in compared to the people doing the real lifting.

Who gives a $hit about credit? How about we just focus on providing good care?

That involves making a diagnosis, communicating with the patient, encouraging appropriate treatment, providing said treatment, and giving support. There's no scorecard and If anyone needs pats on the back and attaboys, I recommend a softball league.

 

[Ceke2002]

Sometimes it works better when the psychiatrist is the bad object. A good idealizing transference makes it easier to develop a solid relationship and connection before the bubble bursts and they begin devaluing me. Seriously though, I have been referred several patients with borderline personality recently who wanted to keep doing "therapy" with the NP who prescribes and I can't break through their initial hostility and feelings of abandonment from the referring provider. Any advice I could give the NP to make for a better hand-off would be helpful. Keep in mind that this NP does not do any psychotherapy and is clear about that, but is very good at developing rapport.

In terms of breaking through resistance and hostility - patience, persistence, find a common ground or interest (things that will at least get the patient talking or spark some sort of engagement), build from there. With the NP, it depends on how she's doing the hand over at the moment. If she's just sending the patient off with a smile and a wave, after building rapport, then the feelings of abandonment are understandable. Maybe see if they'd be willing to adopt more of a step down, transitional approach. So when they know a hand over to another provider is inevitable they can start to gently prepare the patient, and then perhaps for the first month or so after the actual hand over they could agree to allow the patient some limited contact (emails perhaps?) just to help them through the transition so it doesn't feel as if the patient is just being palmed off.

 

[spemat31]

My mom had been diagnosed with borderline PD. She said it was "life experience depression". My aunt was just the same too and they both had normal lives. My grandparents were fresh off the boat from Germany so that may have been it but I remember just going all robotlike and cold when I was 6 after she lured me into her vortex and I ended up getting beat and told I shouldn't have been born. Lucky for me, I later developed a full on manic episode and mine go for almost a year when they are bad. I bet manic patients aren't your forté. I know I irritate all the nurses. But I quit addiction psychology to be a mediator just to get out of that life. My mom passed, I don't deserve to relive that misery.