Treating the Symptoms of Borderline Personality Disorder in Adolescents

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Treating the Symptoms of Borderline Personality
DisorderinAdolescents

• Kerry E. Sebera, PCC
• Licensed School Counselor

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Significance

• Increasingly, community school counselors
  struggling with these issues
• 2-3 of general population and 8-10 of all
  outpatient mental health clients
• Highly crisis-oriented, comprising approx. 40 of
  all hospitalizations (Widiger Weissman)

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Characteristics of Borderline Personality
Disorder

• Often nonexistent parenting conflict early on
• Pattern of intense, unpredictable interpersonal
  relationships, thoughts, affects, and self
  perceptions
• Chronic feelings of emptiness, worthlessness,
  sadness, and anxiety
• Rapid changes between clinginess
  withdrawal/rejection
• Driven by intense fears of abandonment

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• Fear and anger
• Highly dramatic
• Marked fluctuations in self of self
• Do not trust own feelings
• Engage in self-soothing, which can be destructive
• Suicidal ideation gestures
• Cutting/self-mutilation
• Over 50 physically/sexually abused
• Possible neuropsychological deficits
• 3xs more females than males

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How do these symptoms play out in adolescents
life?

• Difficulty relating to others, especially peers
• Often present in crises
• Poor reactions to changes
• Substance abuse
• Misinterpreting significance of relationships
• Reckless behavior
• Running away
• Binge eating
• Sexual promiscuity
• Psychosomatic symptoms
• Commonly fail in education/employment

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Client Needs

• Unconditional positive regard
• Emotional supplies
• Decreasing reactivity
• Monitoring of transference
• Healthy boundaries limit-setting
• Educate
• Advocate for services

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Counselor Issues

• Frustration
• Often increase time talking to colleagues
  decrease time spent with clients (Miller, 1995)
• Countertransference
• Boundaries
• Supervision and support

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Therapeutic Goals Interventions

• Strong therapeutic relationship
• Blackmail therapy
• Consistency
• Understand Emotions
• Validation and positive feedback
• Coordination with Others
• Planning for Crises
• 504 Plans
• Dialectical Behavior Therapy

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Dialectical Behavior Therapy(DBT)

• Work of Dr. Marsha Linehan
• Empirically-validated
• Assumptions
• Doing the best they can
• Want to improve
• Need to try better/harder/be more motivated to
  change
• May not have caused problems, but need to solve
  them anyway
• Lives painful as theyre currently being lived
• Must learn new behaviors
• There is no absolute truth
• Dont assume the worst
• CANNOT FAIL IN DBT

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Dialectical Behavior Therapy(DBT)

• Problems
• Confusion about self
• Impulsivity
• Emotional Instability
• Interpersonal problems
• Adolescent/Family Dilemmas

• Skills
• Mindfulness
• Distress Tolerance
• Emotion regulation
• Interpersonal effectiveness
• Walking the Middle Path

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• Establish Wise Mind
• ACCEPTS
• Activities
• Contributing
• Comparisons
• Emotions
• Pushing away
• Thoughts
• Sensations
• Five senses

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IMPROVE the Moment

• Imagery
• Meaning
• Prayer
• Relaxation
• One thing at a time
• Vacation
• Encouragement

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DBT Groups for Adolescents/Families

• Takes long time commitment
• Selection of members
• Rules
• Therapy-destroying behaviors
• Therapy-interfering behaviors
• Skills groups
• Discussion of self-injury/negative behaviors
• Addressing self-mutilation
• Homework

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Administrative Support

• Share concern re the bottom line
• Explain reduction in cost
• Data
• Highlight overlap with cognitive-behavioral
  therapy
• Collaboration

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• Skills Practice
• Discussion
• Questions