Patients with Borderline Personality Disorder who are Chronically Suicidal: Therapeutic Alliance and Therapeutic Limits

Therapeutic work with patients who are chronically suicidal and have borderline personality disorder (BPD) is challenging, and clinicians often resort to setting firm limits or excessively cautious interventions in efforts to prevent manipulation, regression, or over-dependence. Litigation and malpr...

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Bibliographic Details
Published in:American journal of psychotherapy 2013, Vol.67 (2), p.182-198
Main Author: Jimenez, Xavier F.
Format: Article
Language:English
Subjects:
Adult
Borderline Personality Disorder
Borderline Personality Disorder - therapy
Chronically
Cognitive Therapy - legislation & jurisprudence
Cognitive Therapy - methods
Female
Humans
Interventions
Legality
Litigation
Personality disorders
Phone Coaching
Self destructive behavior
Suicidal behaviour
Suicidal Ideation
Suicide
Suicide - prevention & control
Suicide - psychology
Suicide, Attempted - psychology
Suicides & suicide attempts
Therapeutic Alliance
Therapists
Treatment Outcome
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Description
Summary:Therapeutic work with patients who are chronically suicidal and have borderline personality disorder (BPD) is challenging, and clinicians often resort to setting firm limits or excessively cautious interventions in efforts to prevent manipulation, regression, or over-dependence. Litigation and malpractice fears reinforce these stances, and reduced compensation for additional time and energy devoted to patients adds further disincentives to sole providers. However, elements of the working alliance and therapeutic limits are within the therapist's control. A case vignette illustrates an individual therapist's modification of usual therapeutic limits while working with a chronically suicidal patient with BPD within a dialectical behavior therapy (DBT) framework over a 16-week period. Discussions regarding the case, interventions used, DBT, and legality concerns follow.
ISSN:0002-9564
2575-6559
DOI:10.1176/appi.psychotherapy.2013.67.2.185