Responding to self harm in borderline personality disorder: From clinician frustration to therapeutic enquiry
Lewis, A.J. and Treloar, A.J.C. (2007) Responding to self harm in borderline personality disorder: From clinician frustration to therapeutic enquiry. Psychotherapy in Australia, 14 (1). pp. 34-40.
Pessimistic attitudes and reactive behavioural management strategies act as a major barrier to effective service provision for patients with borderline personality disorder. This paper reviews research on countertransference reactions (negative professional attitudes) towards these patients and the professional response to the common presentation of self harm in this particular client group. The psychotherapeutic treatment of patients with borderline personality disorder is complex and both professionally and personally demanding. A clinical framework is proposed that enables clinicians to develop a more nuanced and empathic understanding of self harm within the context of personality disorder in order to facilitate enhanced therapeutic engagement with these challenging patients. A clinical case study illustrates the use of this framework and the potential for enhanced therapeutic management in conjunction with the recognition and reduction of clinician indifference and rejection, thus improving patient outcomes.
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