Question about working with borderlines

[virgoox]

I work for adolescent crisis line and we frequently respond in teams. Since our work is crisis oriented we do not do a formal therapy session with clients (per se) but we often do a mini session as we have many "frequent flyers". Obviously their diagnosis adds to the fact that we see them all the time because they are often the ones calling us as opposed to their caretakers -which is more often the case.

My question is this.

How do you deal with them in a team setting ? I find that I take the DBT approach which, in comparison to some of my counterparts, seems callous and cold. One of my colleagues rages about DBT but inevitably falls into the borderline trap "Can I buy you a soda?" "Do you think another hospitalization would help you ?" "I know my co worker is mean, but you and I get along right ?"

Talk about staff splitting.

Fortunately I do not get my validation form these kids "calling to talk to me" but my boss always raves about the fact that certain people have a connection to the borderlines (mostly girls) who call us. I don't want to seem inadequate to handle these calls.

I am wondering how to effectively deal with them in a therapeutic way where I can help them but without catering to their manipulations ?

Is this a lose/lose situation due to the nature of the work- (crisis) or possibly the population ?

I don't struggle with any other pops. but again, I am not intrigued or fascinated by Borderlines and maybe my annoyance with them is transparent.

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[Cosmo75]

I might get bashed for this as being too "PC" but in my experience it's better to refer to them as people with borderline personality disorder than "borderlines." I used to do that and was corrected in grad school. Same was true with "schizophrenics" etc. Just an observation.

As for working with these girls, it is very difficult. I have some experience from internship in working with adults with this diagnosis and I had some of the most severe counter-transference issues I've ever experienced. Thankfully I had some good supervision to help me understand their problems a bit better. What I had to constantly keep in mind was that these "manipulators" probably had some very serious and troubling things happen to them to make them behave the way they do. If you can keep that in perspective when trying to work with them, it does make it a bit easier. Not easy

I see you're "pre-psychology" on your status, so I'm guessing you're getting some experience to apply to grad school? If that's the case, then I'd bone up more on trauma theory. I liked "Trauma and Recovery" by Judith Herman. "A Bright Red Scream" is also a good book to read. If you check the "recommended books" thread I'm sure there are others on there to read.

I've used some DBT and I do like it. I think there is a good rationale behind its more rigid structure that may seem stand-offish but sets the boundaries that these patients need. What's important though is for the staff to give a consistent message, and if everyone isn't operating from DBT theory and have loose boundaries, then yes you're going to get serious splitting. That sounds like a nightmare to me.

Good luck!

 

[virgoox]

I wouldn't bash you for being "too PC". I think it is the professional way to refer to patients. I often will let my guard down however when speaking with colleagues because we all assume there is no offense to be taken- also a way to decompress after dealing with crisis for 12 hours. Of course, the SDN forum is not people I know personally so I can "be PC" when needed.

I will bone up on some rsearch- I think that is a good idea. I have gone to so many trainings on BPD yet it has not clicked for me. I may just have to read and read until it drills into my brain.

It is a nightmare when staff do not agree (during a crisis) but unfortunately there is no resolution to this particular situation in my office.

Thanks you for the suggestion!

 

[Therapist4Chnge]

I agree about "person with BPD", though many professionals don't bother with the differentiation.

Cosmo, Herman's "Trauma & Recovery" is an interesting recommendation. It is one of my favorite texts, though looking back I think it could use more of a research foundation. With that being said, I think it is worth reading for anyone interested in trauma.

As for BPD texts....Dr. Marsha Linehan definitely has some great texts, though the ones I am familiar with are more geared towards clinicians. I'm going to poke around my book collection and see if anything pops out, as this is an area of personal interest, though it's been awhile since I've worked in the area.

 

[Cosmo75]

True about Herman's book. I think those 2 books are good reads for getting a better personal perspective on the experience of those who have experienced trauma. Those would be in addition to reviewing the literature, which the OP may have already done.

It is a really interesting area to work, from my limited experience anyway. I'm not sure I could do it though. I feel like I'd burn out pretty quickly. Kudos to those who can do it though.

 

[Wildcat06]

I'm guessing that finding information on working w/ teens w/ BPD would be difficult if not impossible since you can't actually diagnose someone under the age of 18 with an axis 2 disorder, correct? Is there another diagnosis for these kids? Just wondering since I'm working with a similar population.

 

[psyed4clinPhD]

I work for adolescent crisis line and we frequently respond in teams. Since our work is crisis oriented we do not do a formal therapy session with clients (per se) but we often do a mini session as we have many "frequent flyers". Obviously their diagnosis adds to the fact that we see them all the time because they are often the ones calling us as opposed to their caretakers -which is more often the case.

My question is this.

How do you deal with them in a team setting ? I find that I take the DBT approach which, in comparison to some of my counterparts, seems callous and cold. One of my colleagues rages about DBT but inevitably falls into the borderline trap "Can I buy you a soda?" "Do you think another hospitalization would help you ?" "I know my co worker is mean, but you and I get along right ?"

Talk about staff splitting.

Fortunately I do not get my validation form these kids "calling to talk to me" but my boss always raves about the fact that certain people have a connection to the borderlines (mostly girls) who call us. I don't want to seem inadequate to handle these calls.

I am wondering how to effectively deal with them in a therapeutic way where I can help them but without catering to their manipulations ?

Is this a lose/lose situation due to the nature of the work- (crisis) or possibly the population ?

I don't struggle with any other pops. but again, I am not intrigued or fascinated by Borderlines and maybe my annoyance with them is transparent.

Thanks for bringing up this great thread! I also am pre-doctoral student getting experience. While we do have weekly supervision at my job and a DBT consultant, I still have problems with some of our clients who are bordreline. I have found that when I set clear hard boundaries, clients react very poorly. I let my supervisor know this and I think one thing that has helped me in a team setting is to make sure everyone is aware of the boundaries you set so that other providers can also use the same boundaries. I'm not sure if this will work in your situation, but it has helped me some...

 

[Cosmo75]

I'm guessing that finding information on working w/ teens w/ BPD would be difficult if not impossible since you can't actually diagnose someone under the age of 18 with an axis 2 disorder, correct? Is there another diagnosis for these kids? Just wondering since I'm working with a similar population.

Correct. I'm not aware of another diagnosis for these adolescents. So I suppose they have borderline traits. There's actually an article on non-suicidal self-injury on the psychotherapy brown bag blog this week (7/24/09). I'm not suggesting that all self-injurers have BPD, but it may be something that the OP is also working with.

http://www.psychotherapybrownbag.com/

You bring up a good point about what I see as a larger issue in psych in that we are diagnosing kids earlier on with what were traditionally more "adult" problems. I'm thinking specifically of bipolar DO, but BPD could fall in there as well. When I did assessments in schools for my diagnostic practicum, it seemed like every 4th kid had a bipolar dx, and many of them were teenage girls. I had a hard time with what seemed like over-pathologizing what was once considered normal teenage behavior. Not saying what is always considered normal is correct, but it seemed excessive.

 

[cara susanna]

If you're interested in NSSI research, Jennifer Muehlenkamp also works in that area.