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Wednesday, March 28, 2012
When considering the role of a psychotherapist, one should consider how they interact with a client or patient who has a rather dysfunctional personality. A healthy personality involves the ability for someone to integrate new experiences into their current patterns of thinking (i.e. values, beliefs, and behavior – which make up their core personality.) When someone fails to integrate new experiences, they could possibly be diagnosed as having a personality disorder to include Borderline Personality Disorder (BPD). While all of us will encounter times when things are difficult, a BPD diagnosis happens when a person has a long-term integration problem that is acted out in the form of strong emotional reactions.
Normally such a person does this because earlier in life when their brain was not fully formed. At that point, their emotional brain [i.e. limbic system and especially the hippocampus (memory) and amygdala (anger and defensiveness)] were the only coping structures currently available. When this reactive pattern is hardwired into these structures, they continue to reactively respond in a pre-conscious manner well throughout life. Triggering events that can cause this are early childhood trauma such as abuse or witnessing an event or long-term situation for which the more rational and logical structures not yet available.
Like working with trauma patients, who represent the most extreme examples of this problem, the role of the therapist is to help their client or patient reorient to the present space and time and then give them the tools that will help them both integrate past events in a logical way and better cope with future events.
Dangers may first occur when a patient has an extreme “inner phobia.” This is more so the case with extreme trauma victims rather than BPD. Any effort to get the patient to return focus on the here and now can be dangerous. (A lot of mental problems occur when subjects are attempting to integrate unresolved past or anticipated future problems.) The other problem occurs when the therapist expects progress to happen too quickly. While I love rapid therapy techniques, for severe trauma or BPD cases, it takes a long time for the client to change how their brain has been wired. However, it can be done.
Therefore, if you look at the therapist as being an enabler, I would say that their role is to gently help their client on the path to recovery. They need to be extremely safety minded so as not to allow inner phobia problems re-traumatize their client. Secondly, as the therapeutic process requires the therapist to gently introduce effective interventions, they must realize that these too are events that the patient must integrate. If they are already having problems with their integration capabilities – as evidenced by the presenting problem – then the therapist is both helping (i.e. enabling) them create the ability to integrate the therapy, integrate past (and possibly anticipated) events, as well as strengthening their ability to integrate anything that life presents.
Keywords: Psychotherapy, bpd, borderline personality disorder, counseling, psychology
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