What should a therapist know before treating a borderline patient?
The therapist who wishes to treat a patient with borderline personality disorder (BPD) must possess some specific characteristics. Their personality will determine the working profile, favoring or not the establishment of a good bond and the overall progress of treatment.
Therapy is the central point of this treatment, which requires a collaborative effort from a team composed of various professionals such as psychiatrists, individual therapists, group therapists, family therapists, nurses, among others.
The primary function of therapy is to strengthen the patient's ability to think. After all, they have difficulty reflecting on their own life and everything that surrounds it. Moreover, they exhibit many behaviors that compromise the proper functioning of life, potentially putting it at risk through alcohol and drug abuse, unsafe sex, abusive relationships, etc. Some may engage in self-harm and suicide attempts.
The difficulty in conducting relationships in a healthy manner is brought into the therapy room and repeated in the relationship with the therapist. There, they may promote numerous disruptions to treatment, such as frequent absences, arriving late, being aggressive in speech, remaining silent in therapy, or, conversely, speaking all the time and thus preventing the therapist from making certain remarks. They may even devalue the professional by not paying their fees or delaying payment for a long time.
This scenario is frustrating for the therapist, who may become confused and feel powerless as a professional. They may also react by giving advice as a mother would, doing more for this patient than for others. These are difficult feelings to tolerate and manage, causing many professionals to give up on treating this patient.
Therefore, some of these professionals do not treat or avoid this patient, even though they may be very competent in treating other profiles. Those who decide to treat them do so because, despite the frustration they feel at many moments, they feel compelled and encouraged to seek clinical supervision and literature that addresses this topic.
They have temperament traits such as novelty-seeking, harm avoidance, high persistence (high frustration tolerance), and minimal dependence on gratification. These traits facilitate the therapeutic bond and work. It is worth noting that temperament is inherited and therefore varies little over time and circumstances. (Sassi and Zito)
They are usually affectionate and caring towards others. They have a gaze focused more on the person who has the illness than on the illness the person has. (Hippocrates). They are respectful, empathetic, courageous, have the ability to contain (the patient's anxieties and their own), are patient, have intuition, are authentic, and have the ability to survive. (Zimerman, Bion, Winnicott, and Gabbard).
Some of these characteristics can be acquired, that is, developed through personal therapy, case supervision, specific courses, and readings. Without this tripod, a good therapist will not be formed, regardless of the patient they choose to treat.
BIBLIOGRAPHICAL REFERENCES
1. Gabbard, Glen O. Psiquiatria psicodinâmica na prática clínica. 5. Ed. – Porto Alegre: Artmed, 2016.
2. Rosenfeld, Herbert A., Alguns fatores terapêuticos e antiterapêuticos no funcionamento do analista, in: 1910 – 1986. Impasse e Interpretação: fatores terapêuticos e antiterapêuticos no tratamento psicanalítico de pacientes neuróticos, psicóticos e fronteiriços. Rio de Janeiro: Imago Ed., 1988.
3. Zimerman, David E. A pessoa real do analista no processo psicanalítico, in: Manual de técnica psicanalítica: uma re-visão. Porto Alegre: Artmed, 2004.
4. Condições necessárias para um analista, in: Manual de técnica psicanalítica: uma re-visão. Porto Alegre: Artmed, 2004.
5. Zito, Daniely Marin; Sassi Junior, Erlei. Psicoterapia Psicodinâmica Modificada Para Transtorno de Personalidade Borderline: O Método.