Client Information
The client is a fifty-one-year-old female. During the session, she appeared distressed. The woman argued that she was feeling better than usual at the time of the meeting. However, she was somewhat disheveled in her statements. The patient’s speech was clear, but she did not talk about her issues in much detail. The client answered all questions and recalled the history of the presenting problem without many complications. Moreover, she spoke about her previous diagnoses and current medications in specific terms. However, the patient’s description of her feelings and actions lacked certainty and clarity. She did not respond negatively to the questions posed by the therapist and agreed with the proposed suggestions. The patient expressed feeling tired of continuous treatment and regular hospitalizations and wanted to find the diagnosis that would allow her to take care of her child and get better.
During the session, the woman stated that she often thought about suicide, which should put her at risk of self-harm and possible suicide attempts. Moreover, the patient indicated that she harmed herself numerous times. While those incidents were not lethal, they show that her behavior is unstable and requires more attention. It is possible to assume that while the client is exhausted from her previous treatments, she is ready to cooperate with the therapist. Her behavior shows that she has many hard days during which she feels hopeless or angry. Nevertheless, she remains active in her search for better treatment.
Presenting Problem
The client’s primary concerns include her feelings of depression, anger, and hopelessness that interchange during the day. The patient stated that she felt depressed at all times. However, her mood becomes worse during the night. Her intrusive thoughts about suicide and self-worthlessness affect her sleep. Therefore, the patient suffers from insomnia as well. The patient also described being somewhat impulsive in her decisions as she was prone to self-mutilation. In fact, she inflicted harm on herself before, stating that she stabbed herself in the shin. During the session, the client noted that pain made her feel better in that specific moment. Thus, the danger of suicidal tendencies grows as the woman finds comfort in the process of self-harming. Her behavior changes throughout the day and she often experiences inappropriate anger episodes and intrusive thoughts. These issues influence the patient’s daily activities.
According to the description of the client’s problems, one can suggest the diagnosis of borderline personality disorder (BPD). Gunderson, Weinberg, and Choi-Kain (2013) state that BPD can be characterized by unstable attitude, recurrent suicidal thoughts, self-mutilating behavior, and chronic feelings of emptiness and paranoia. The description of the patient’s concerns aligns with this particular diagnosis. Moreover, the lack of control over the client’s emotions and moods further suggests her having BPD. Her dichotomous thinking, often present in BPD patients, can be observed in her discussing the value of her life and her relationship with her daughter. While she frequently feels hopeless and tired, she wants to take care of her daughter and have a stable and good relationship with her. Moreover, it is possible that the patient tries to hide her negative attitude at the fear of abandonment. This factor also strongly suggests the presence of BPD.
The patient states that such suicidal ideations and mood changes started happening approximately twenty years ago when the client was around thirty years old. However, the woman began to see various therapists and psychiatrists over ten years ago. Since that moment, she has been hospitalized eight times and diagnosed with multiple disorders such as schizophrenia, bipolar disorder, and dissociative identity disorder. She was prescribed numerous psychotropic medications. Currently, the client takes a number of drugs such as Zyprexa, Wellbutrin, Lithium, Depakote, and Klonopin. She noted that these medications allowed her to become less distressed and not as emotional as usual. Without taking the drugs, she feels angry, depressed, and antisocial. The history of the expressed problem suggests that the patient’s issue has not been diagnosed correctly. While the client stated that her medications made her feel better than before, she seemed to be dissatisfied with their effect as she still had intrusive thoughts and negative moods. Thus, the previous diagnoses should be taken into consideration as they significantly affected the client’s current situation.
Family Information
The patient’s relations influence her current state significantly. The woman is divorced and has a twelve-year-old daughter. The client noted that her husband left her and her daughter, which placed the two individuals in a challenging position. The patient has a good relationship with her child, although there are some incidents when the daughter is afraid of her mother’s behavior. The woman stated that her ex-husband was the person that looked after her daughter while she was at the hospital. This fact suggests that the relationship between the father and the daughter is not as bad as one might assume. It is unclear whether the husband left the family a long time ago. Furthermore, his reasoning was also not discussed during the session. It is possible, however, that this incident affected the patient’s mental state and exacerbated some of the symptoms, although the woman argued that she had many bad days in marriage as well.
The woman is determined to get better. She noted that she was tired of being a patient and being regularly hospitalized. While during her stay at a hospital the client felt more in control over her actions and feelings, she was unable to take care of her daughter. This fact is a strength of the patient on which one should focus while choosing the type of treatment. The woman is concerned with her ability to raise her child, and she loves her daughter very much. Therefore, her desire to become a patient once again is driven by this factor. Moreover, she has a good relationship with her daughter, which also motivates her to move forward. Spending time with her child helps the client to deal with her emotions and manage some of the intrusive thoughts. On the other hand, the woman’s relationship with her husband may negatively affect her treatment. Regular hospitalization can also aggravate her fear of abandonment. The husband is the one to look after the woman’s daughter during her stay at the hospital, which may prompt the client to think that she is being left alone by her family.
Evidence-Based Change Strategies
The patient’s further treatment can include some possible strategies. First of all, it is vital to discuss the issue of safety with the client as her history of self-harm may pose a threat to her life. Although the patient did not present a clear plan of action connected with a suicide attempt, she did specify an occasion where she deliberately hurt herself. Therefore, one should assure the patient that therapy will help her to get better and she should be mindful of harming herself to reach the end of the treatment without any complications. According to Tomko, Trull, Wood, and Sher (2014), patients with BPD often suffer from a combination of recurrent suicidal behavior and impulsive attitude. Therefore, it is necessary for the therapist to explain the importance of safety to the patient.
Some recommendations can be given to the client in case she is feeling suicidal. She should call 911 if her condition is unstable. Also, calling the National Suicide Prevention Lifeline is an option that the woman should take into consideration. This particular service may offer support and guidance in a situation when the therapist is unavailable. Furthermore, the patient’s daughter may be the primary strength that should be addressed during treatment as the woman is significantly affected by their strong bond. Thus, one can recommend to the patient to spend more time with her daughter and focus on positive experiences and feelings. The client’s condition may be worsened by hospitalization as she fears abandonment and is tired of not being at home for weeks or months. Although it may be required for the patient be hospitalized in case of an emergency, she can avoid that by focusing on other types of therapy.
BPD is a condition that requires the treatment of the patient’s emotional state with the focus on negative and positive emotional experiences. According to Neacsiu, Lungu, Harned, Rizvi, and Linehan (2014), dialectical behavioral therapy (DBT) is one of the most effective treatments of BPD. This kind of therapy is concentrated on the process of dealing with negative emotions and learning to cope with them rather than neglect them. The patient can work on her emotional vulnerability and accept that her good days will be followed by some bad days. Moreover, she can devise a system of support that would help her to go through a bag phase without many adverse outcomes. Such activities as interaction with family, emotion regulation techniques, and therapy may be included in the system.
References
Gunderson, J. G., Weinberg, I., & Choi-Kain, L. (2013). Borderline personality disorder. Focus, 11(2), 129-145.
Neacsiu, A. D., Lungu, A., Harned, M. S., Rizvi, S. L., & Linehan, M. M. (2014). Impact of dialectical behavior therapy versus community treatment by experts on emotional experience, expression, and acceptance in borderline personality disorder. Behaviour Research and Therapy, 53, 47-54.
Tomko, R. L., Trull, T. J., Wood, P. K., & Sher, K. J. (2014). Characteristics of borderline personality disorder in a community sample: Comorbidity, treatment utilization, and general functioning. Journal of Personality Disorders, 28(5), 734-750.