Borderline Personality Disorder A Clinical Guide 2nd Edition by John Gunderson, Paul Links 1585623350 9781585623358

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ISBN 10: 1585623350

ISBN 13: 9781585623358

Author: John G. Gunderson, Paul S. Links

 

Covering the range of clinical presentations, treatments, and levels of care, Borderline Personality Disorder: A Clinical Guide, Second Edition, provides a comprehensive guide to the diagnosis and treatment of borderline personality disorder (BPD). The second edition includes new research about BPD’s relationship to other disorders and up-to-date descriptions of empirically validated treatments, including cognitive-behavioral and psychodynamic approaches. Compelling new research also indicates a much better prognosis for BPD than previously known.

A pioneer in the field, author John Gunderson, M.D., director of the Borderline Personality Disorder Center at McLean Hospital, draws from nearly 40 years of research and clinical experience. The guide begins with a clear and specific definition of BPD, informed by a nuanced overview of the historical evolution of the diagnosis and a thoughtful discussion of misdiagnosis. Offering a complete evaluation of treatment approaches, Dr. Gunderson provides an authoritative overview of the treatment options and describes in-depth each modality of treatment, including pharmacotherapy, family therapy, individual and group therapy, and cognitive-behavioral therapies.

Unlike other works, this book guides clinicians in using multiple modalities, including the sequence of treatments and the types of changes that can be expected from each mode. The discussion of each treatment emphasizes empirically validated therapies, helping clinicians choose modalities that work best for specific patients. In addition, Borderline Personality Disorder: A Clinical Guide, Second Edition, also outlines therapeutic approaches for multiple settings, such as hospitalization, partial hospitalization or day hospital programs, and levels of outpatient care.

Complementing the well-organized treatment guide are a series of informative and intriguing sidebars, providing insight into the subjective experience of BPD, addressing myths about therapeutic alliances in BPD, and questioning the efficacy of contracting for safety. Throughout the book, Dr. Gunderson recommends specific do’s and don’ts for disclosing the diagnosis, discussing medications, meeting with families, starting psychotherapy, and managing suicidality.

A synthesis of theory and practical examples, Borderline Personality Disorder: A Clinical Guide, Second Edition, provides a thorough and practical manual for any clinician working with BPD patients.

Borderline Personality Disorder A Clinical Guide 2nd Table of contents:

1 The Borderline Diagnosis

Origins of the Diagnosis

Shifts in the Borderline Construct: From Organization to Syndrome to Disorder

Epidemiology

An Explication of the DSM-IV Criteria

A Clinical Synthesis: Intolerance of Aloneness

Misuses of the Borderline Diagnosis

The Behavioral Specialty: Self-Injurious Behavior

Use of the Diagnosis in Adolescents

How to Explain the Diagnosis

Summary

References

2 Differential Diagnosis: Overlaps, Subtleties, and Treatment Implications

Overall Function

The Changing Construct: From Schizophrenia to Depression to Posttraumatic Stress Disorder to Bipolar Disorder

Comorbidity and Differential Diagnosis

Summary

References

3 Overview of Treatment

Historical Overview

Generic Therapeutic Processes and the Functions They Serve

Multiple Modalities and Step-Down Services: An Overview

Sociotherapies

Establishing Goals: The Expectable Sequence of Change

Changes Within Four Spheres

The Initial Structuring of Treatment

Types and Sequence of Therapeutic Alliance

Countertransference

Summary

References

4 Case Management: The Primary Clinician

Qualifications

Responsibilities

Liability Issues

Relationship Management

Managing Safety

Responding to Recurrent Suicidality: The Principle of False Submission

Implementing Changes

Boundaries, Violations, and Setting Limits

Splits, Splitting, and the Virtues of Split Treatments

Giving, Receiving, and Participating in Supervision

Summary

References

5 Levels of Care: Indications, Structure, Staffing

Selecting or Changing a Level of Care

Level IV: Hospital Treatment—Makes Therapy Possible

Level III: Residential/Partial Hospital Care/Day Treatment—Basic Socialization

Level II: Intensive Outpatient Care—Behavioral Change

Level I: Outpatient Care—Interpersonal Growth

Summary

References

6 Pharmacotherapy: Clinical Practices

History

Overall Role of Medications

Getting Started

The Prescribing Psychiatrist’s Role

Symptom Chasing

Attitudes, Meanings, and Attributions

Transference-Countertransference Issues

Contraindications and Discontinuance

Summary

References

7 Pharmacotherapy: Selection of Medications

Pharmacotherapy Models

The Symptom-Targeted Model

Summary

References

8 Family Interventions and Therapies

History

Therapists and Countertransferences

Getting Started: Overcoming Resistance

Phase 1: Initial Family Meetings

Phase 2: Establishing an Alliance

Phase 3: Psychoeducational Family Therapy

Phase 4: Psychodynamic Family Therapy

Marital or Couples Therapy

Summary

References

9 Group Therapy

Indications

Engaging Patients and the Primary Clinician’s Role

Skills Training Groups

Psychodynamic Group Therapies

Group Structure

Common Problems

Summary

References

10 Individual Psychotherapies: Getting Started

Introduction: Prerequisites

Getting Started

Structuring the Therapeutic Frame (External Boundaries)

Therapists

Engagement

Generic Qualities of Effective Psychotherapies

Summary

References

11 Cognitive-Behavioral Therapies: Dialectical Behavior Therapy and Cognitive Therapies

Overview

Basic Operant Conditioning Applications for All Treatment Settings

Dialectical Behavior Therapy

Cognitive Therapies

Summary

References

12 Psychodynamic Psychotherapies

Pre-Empirical Developments

Outcome Studies: Nonrandomized Trials

Transference-Focused Psychotherapy

Overview of Change Processes

Phase 2: A Relational Alliance

Phase 3: Positive Dependency

Phase 4: Secure Attachment, the Working Alliance, and Consolidation of Self

Impasses

Summary

References

13 Future Considerations

Treatment Implications

Diagnostic Implications

Public Awareness and Advocacy

Summary

References

Appendix Psychoeducational Resources: Printed Materials, Videos, Films, and Web Sites

Printed Materials

Videos

Films

Web Sites

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