Download Sexual abuse and Borderline Personality Disorder: The

Sexual Abuse and Borderline
Personality Disorder: The
Process of Therapy
M. Sc. Teja Bandel
Psychologist
Borderline Personality Disorder & Sexual
Abuse
• BPD: Pervasive pattern of instability of interpersonal
relationships, self-image, affects, and marked impulsivity
• Begins by early adulthood and is present in a variety of
contexts.
• Frantic efforts to avoid real or imagined abandonment.
• The perception of impending separation or rejection, or
the loss of external structure, can lead to profound
changes in self-image, affect, cognition, and behavior.
• Very sensitive to environmental circumstances
• Trauma (sexual abuse) plays a significant role in the
psychogenesis of borderline states.
Characteristic of the client
• Woman, 36 years old
• Reffered to Vocational Rehabilitation Centre
(URI-Soča) from Employment Agency (ZRSZ)
for an assessment of the level of work ability,
knowledge, work habits and vocational interests.
• Efficiency in working environment was unstable
and under an influence of health problems.
• Sexual, emotional and physical abuse from
childhood (still occuring, different persons).
• Dealing with numerous physical health
problems, of which many of them only partially
explained.
• Numerous mental health problems (BDP,
depression, anxiety, eating disorders) &
hospitalizations in psychiatric hospital.
• Oscillating intake of medication (“self-treatment”)
• Engaged in numerous treatments, blaming
others for the failures.
• Shy, reserved, non-assertive, uncommunicative
but at the same time revealing the most intimate
contents in first contact.
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Disorganized type of attachment.
Low self-esteem, self-confidence, self-image.
Impaired body image.
Prone to self-injuries, suicidal behaviour,
impulsivity.
Mood lability, constant fear of abandonement.
Cognitive impairment/dissociative symptoms
(memory).
Manipulative behaviour.
Family characteristics.
• Reporting unstable and harmful
relationships characterised by alternating
idealisation and devaluation (when she is
“betrayed”).
• Defense mechanisms: regression, multiple
decompensations
• Type of communication: repetitive and
simple sentences, irrelevant topics were
exposed, usually starting with “I want to
say goodbye, I can’t handle it anymore”.
• Changing mind all the time, without
reasons.
Process of therapy
• Individual therapy
• 1x per week
• Intense countertransference: feelings of
anger, hatred, disgust and reluctance
toward the client.
• Projections often positioned me as
agressor and her as a victim, I felt
exposed and vulnerable,
• Constant presence of fear of abandonement and
clinging to therapist
• Manipulative behaviour, “threatening” with suicide
• No progress in 6 months, eventhough she was
expressing a desire for it
• Without specific goals
• Double-bind communication
• Transmition of responsibility for change on
therapist
• Basic affects: anger, fear, shame, guilt
What was efficient?
• Importance of providing secure attachment and
predictive environment with the purpose to
decrease feelings of abandonment through the
constant presence regardless of client's
behavior.
• Goal setting was not successful at the
beginning.
• Client as well needed to feel that her narratives
was believed.
• Revealing how the therapist felt.
• Addressing the manipulative behaviour
(double-bind communication) all the time.
• Client was out of touch with her feelings,
affects, thoughts, beliefs, sensations.
• This steps were significant to take before it
was possible to address affects as anger,
fear, shame and guilt.
Results
• Decline of suicidal ideations.
• More stable mood.
• Trying to move from the unsafe
environment.
• Capable of talking about feelings and
events more sistematically.
Thank you for your attention and
interest.
Please feel free to ask questions.
[email protected]
+386 1 47 58 181