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Theoretical Orientations and Interventions (Dialectical Behavior Therapy)
The theoretical orientations used in the case with Karen, who was diagnosed with borderline personality disorder (BPD), are based on the dialectical behavior therapy. Consistent with this approach, doctor Banks considered two main treatment formats, such as group sessions and individual meetings with the client. More to the point, she offered the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) instrument that allowed revealing the disease and deciding on the corresponding treatment. For example, she showed unstable self-image and a constant feeling of emptiness. In order to ensure the compliance with the theoretical orientations, Dr. Banks divided the therapy into four stages, which were consistent and patient-oriented, leading to better health outcomes.
The pivotal assumption of the dialectical behavior therapy is related to the childhood of a person. For example, if a child was subjected to sexual assault or his or her behavior lacked support and understanding, this is likely to cause BPD in adults aged 25 and older (Gorenstein & Comer, 2015). Among the six key issues that are targeted by the mentioned therapy, there is a focus on basic functioning, survival promotion, the improvement of behavioral skills, addressing therapy-interfering behaviors, eliminating suicidal intentions, and discussing behaviors that inhibit the quality of life.
Primary Goal, Treatment Formats, and Stages
During the pre-treatment stage, the doctor tried to ask Karen to receive the therapy by explaining its fundamentals and potential positive impact. Paying attention to the patient’s history of impulsivity, suicidal attempts, and perceived abandonment, Dr. Banks clarified that the offered therapy can help her (Sneed, Fertuck, Kanellopoulos, & Culang-Reinlieb, 2012). Also, the previous treatment attempts that ended unsuccessfully were taken into account as a primary goal. In particular, to make the treatment more effective, Karen was told that she would receive two formats of assistance. The first format is group training, when people with the same or similar diagnosis learn to master behavioral skills, including emotional control, consciousness, and other self-management skills. Distress tolerance and interpersonal skills can also be noted as those that are to be developed during the group sessions. The individual program is the second format that implies one-to-one consultations on the ways to apply the skills acquired to real life. In other words, the individual format is beneficial to work with the situations and questions that occur at the moment.
The dialectical behavior therapy consists of four parts, such as pre-treatment, first, second, and third stages. The second stage aims at decreasing the capacity of Karen’s negative memories associated with her sexual abuse in childhood (Rizvi, Steffel, & Carson-Wong, 2013). This stage offers the techniques that help people with BPD to calm down and avoid the deterioration of self-damage intentions. Since she learned to address adverse thoughts by eating her favorite food or doing other pleasant issues during the first stage, the second one used the controlled stimuli to expose the patient to her past trauma. It allowed reducing Karen’s distress level, and starting the third stage of the treatment. The latter focuses on the long-term goals related to career, relationships, and self-respect. In this case, the client naturally came to this stage as her behavioral patterns were stabilized, and valuing herself was improved. In other words, the expected outcome of this stage is that the patients cease to commit negative actions based on their memories and driven by current difficulties.
Role of Consulting and E-Therapy
The work with a counseling psychologist seems to be essential in case of Karen as she may need periodical help with managing her emotions and relationships across her lifespan. Due to the fact that the identified professional specializes in a variety of areas, consulting is likely to enhance social, emotional, educational, career, and developmental aspects of Karen’s life. Most importantly, counseling psychology implies a long-term perspective on the very process of treatment and its outcome as well as related training and prevention of recidivism. According to Luxton, Pruitt, and Osenbach (2014), telehealth is one of the innovative tools that may be used to assess the patient’s condition and adjust the therapy. Before applying nay technology, the doctor should make sure that the client is comfortable with it.
In case of Karen, one may recommend the application of portable video telephone equipment with a video processing system. Miller (2006) suggests that it provides the opportunity for the interprofessional team to communicate with patients. Another benefit for mentally ill clients is the ability to observe their facial expressions and assess the voice and gestures. These issues are likely to contribute to greater understanding of Karen’s state and treatment progress. As for the liability of video telephone equipment, it should be stressed that the risk of negligence and abandonment should be considered by care specialists (Miller, 2006). The failure to provide a fill specter of services during telehealth sessions and termination of care without proper reasons may deteriorate the emotional and psychological health of patients. Therefore, the release of liability form should be given to both clients and care providers.
Treatment Interventions’ Effectiveness and Recommendations
All the interventions conducted by Dr. Banks and based on the dialectical behavioral therapy proved to be effective. The key outcomes that were achieved as a result of the four stages of the treatment are the increased self-appraisal and no continuing cases of self-damage (Rizvi et al., 2013). Since the therapy was implemented in stages, both formats, individual and group sessions, were useful for Karen to build behavioral skills and accomplish emotional self-control. In addition, the case shows that she became interested in career opportunities as well as more stable interpersonal relationships (Gorenstein & Comer, 2015). The process of addressing the destructive behavior was associated with the increasing sense of understanding that her memories should not force her to commit suicide. Instead, such symptoms as the perceived abandonment and extremely emotional reactions become less pronounced, which is consistent with Harned, Tkachuck, and Youngberg (2013). In particular, the change in Karen’s worldview and self-image was achieved in both short- and long-term periods.
Based on the current improvements and the patient needs, one may recommend the use of pharmacotherapy to stabilize Karen’s mood by means of psychotropic agents, achieving more constant results (Sneed et al., 2012). The American Psychiatric Association also pinpoints the schema-focused therapy as the alternative option, which can be applied if Karen will have more BPD cases in the future. It implies using the psychological constructs, including bodily expressions, memories, and the adaptation of clients’ believes. The third recommendation refers to the mentalization-based therapy to be performed in hospital settings, which is especially important if the patient fails to establish appropriate relationships with others. This method works with attitudes, desires, and feelings of patients to change their mental status and improve the way they act and think.
References
Gorenstein, E. E., & Comer, R. J. (2015). Case studies in abnormal psychology (2nd ed.). New York, NY: Worth Publishers.
Harned, M. S., Tkachuck, M. A., & Youngberg, K. A. (2013). Treatment preference among suicidal and self-injuring women with borderline personality disorder and PTSD. Journal of Clinical Psychology, 69(7), 749-761.
Luxton, D. D., Pruitt, L. D., & Osenbach, J. E. (2014). Best practices for remote psychological assessment via telehealth technologies. Professional Psychology: Research and Practice, 45(1), 27-35.
Miller, T. W. (2006). Telehealth issues in consulting psychology practice. Consulting Psychology Journal: Practice and Research, 58(2), 82-90.
Rizvi, S. L., Steffel, L. M., & Carson-Wong, A. (2013). An overview of dialectical behavior therapy for professional psychologists. Professional Psychology: Research and Practice, 44(2), 73-80.
Sneed, J. R., Fertuck, E. A., Kanellopoulos, D., & Culang-Reinlieb, M. E. (2012). Borderline personality disorder. In P. Sturmey & M. Hersen (Eds.), Handbook of evidence-based practice in clinical psychology: Vol. 2. Adult disorders. (pp. 507-529). Hoboken, NJ: John Wiley & Sons.
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