Therapy for Clients With Personality Disorders

Therapy for Clients With Personality Disorders

Succinctly, in 1–2 pages, address the following:

Briefly describe the personality disorder you selected, including the 
DSM-5-TR
 diagnostic criteria.

Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.

Next, briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client in order to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session

Borderline Personality Disorder AND Narcissistic Personality Disorder

Therapy for Clients With Personality Disorders – Borderline Personality Disorder

Personality Disorder DSM-5-TR Overview

Borderline Personality Disorder (BPD) is a type of personality disorder that involves an unstable and disturbed pattern of mood and interpersonal relationships, as well as irresponsible behavior. The DSM-5-TR diagnostic criteria for BPD include sudden panic, the absence of a stable and secure attachment figure in their childhood, a constantly shifting sense of self, suicidal tendencies when overwhelmed by negative emotions, bipolar disorder-like tendencies, pervasive and persistent existential depression, rage reactions, brief psychotic episodes that manifest as paranoia, and split-off ego states (Leichsenring et al., 2024). According to DSM 5, the patient requires at least five of these characteristics are necessary for diagnosing the disorder. Interpersonal conflicts and perceived abandonment significantly increase emotional sensitivity, impulsivity, and self-harm in BPD. The sooner the diagnosis is made and treatment commenced, the better the prognosis.

Therapeutic Approach for Managing Borderline Personality Disorder

Dialectical Behavioral Therapy (DBT) is an efficient treatment method for managing BPD. DBT utilizes cognitive-behavioral approaches, but it is based on the principles of mindfulness. This modality aims to equip BPD clients with skills to control their emotions, cope with stress, and enhance their relational capabilities, making it suitable for treating the aspect of BPD that involves poor emotion regulation (Kujovic et al., 2024). This structure of DBT may be useful for clients with BPD, as it encourages the replacement of self-harming behaviors with better coping skills over time (Leichsenring et al., 2023).  Behavioral skills training further incorporates group and individual therapies to establish an organizational format to elicit healthier emotional reactions and improve Interpersonal communication skills.

Therapeutic Relationship in Psychiatry

In psychiatry, a therapeutic relationship can be described as a working partnership between the therapist and the client that involves trust, helpful communication, and participation in the therapeutic process. It is underpinned by empathy, respect, and positive regard for the client; they are encouraged to discuss their problems in this therapeutic alliance. Developing this trust is vital as it facilitates communication and compliance with the stipulated therapy regimes (Kujovic et al., 2024). Thus, therapists should be aware of possible power relations that impact the process and be open about this to foster a constructive relationship during the therapeutic process.

Sharing Diagnosis with the Client

The nurse practitioner should provide details on the patient, ensuring an understanding of the condition and the treatment plan that should be implemented. Therefore, when explaining BPD to a patient, concerns should be presented non-judgmentally, emphasizing positive qualities. I would describe the symptoms in basic language, noting how these characteristics may affect feelings and interpersonal connections and stressing the potential for recovery through medication. I emphasize that the diagnosis is driven by explaining the symptoms, prognostication, and treatment strategies (Wheeler, 2020). Applying this strategy could help the client gain more control over the process. It would not compromise the therapeutic alliance that personality disorder diagnoses often produce feelings of stigma or alienation.

 

 

Individual vs. Family vs. Group Session Disclosure

In the individual context, it would be critical for the nurse practitioner to explain the diagnosis, emphasizing the individual impacts of the disease and approaches for enhancing recovery. On the other hand, in the family setting, the approach should focus more on enhancing the family’s understanding of the diagnosis and the existing needs associated with the condition. The family setting interventions focus on empowering the patient and the family to understand their roles in managing the condition and address any myths and misconceptions that may affect the management of the condition. However, a group setting offers optimal opportunities for sharing experiences where patients can learn from one another and develop resilience in managing their conditions and needs (Wheeler, 2020). These settings require managing individual needs and preferences and maintaining privacy to help build trust, maintain therapeutic relationships, and foster mutual support.

 

 

References

Kujovic, M., Benz, D., Riesbeck, M., Mollamehmetoglu, D., Becker-Sadzio, J., Margittai, Z., Bahr, C., & Meisenzahl, E. (2024). Comparison of 8-vs-12 weeks adapted dialectical behavioral therapy (DBT) for borderline personality disorder in routine psychiatric inpatient treatment: A naturalistic study.
Scientific Reports
,
14
(1), 11264.
https://doi.org/10.1038/s41598-024-61795-9

Leichsenring, F., Fonagy, P., Heim, N., Kernberg, O. F., Leweke, F., Luyten, P., Salzer, S., Spitzer, C., & Steinert, C. (2024). Borderline personality disorder: A comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies.
World Psychiatry: Official Journal of the World Psychiatric Association (WPA)
,
23
(1), 4–25.
https://doi.org/10.1002/wps.21156

Leichsenring, F., Heim, N., Leweke, F., Spitzer, C., Steinert, C., & Kernberg, O. F. (2023). Borderline personality disorder: A review.
JAMA
,
329
(8), 670–679.
https://doi.org/10.1001/jama.2023.0589

Wheeler, K. (2020).
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
(3rd ed.). Springer Publishing Company.

 

 

Therapy for Clients with Personality Disorders – 
Narcissistic
Personality Disorder

Briefly describe the personality disorder

Narcissistic personality disorder (NPD) is a psychiatric disorder marked by lack of empathy, need for admiration, and persistent pattern of grandiosity. NP is associated with a heightened risk of comorbid conditions, including anxiety and mood disorders; suicide substance and alcohol use disorders; and marital, relational, and vocational problems.  Narcissistic individuals are highly distressed, make others go through much pain, and have reduced quality of life (Weinberg & Ronningstam, 2022).  According to the DSM-5 diagnostic criteria, symptoms of NPD include limited ability to be empathetic, grandiose and entitled perception of self, arrogance, a disparate need for admiration and attention, being envious or believing others are envious of self, a propensity to destroy relationships, and desire for high status and exceptional achievements(Szalay et al., 2024).

A therapeutic approach and a modality to use to treat a client presenting with the disorder

Psychotherapeutic treatment for NPD is challenging since individuals with NPD feel ashamed of being reliant on others, a thing that makes it difficult to rely on healthcare providers. Also, they can envy the therapist along with their supposed status, which usually ignites a feeling of competitiveness (Szalay et al., 2024). Mentalization-based therapy (MBT) is a therapeutic approach I would use with a patient presenting with NPD. According to (Choi-Kain et al., 2022) metallization refers to the way humans understand their social interactions by considering the mental states (for example, intentions, desires, beliefs, and emotions) that reinforce observed behavior. Mentalizing enables an individual to create and sustain gratifying relationships and for other people to understand them in a manner that ignites a positive identity. MBT is the most appropriate therapy for NPD because it addresses personality dysfunction connected with coping in relational and self-management. MBT achieves this by augmenting contemplative abilities about self and other, stabilizing attachment, and promoting epistemic trust.  An individual with NPD have a high likelihood of being avoidant or dismissive in terms of vulnerabilities, emotional, and attachment, and the contributions and perspectives of other people (Choi-Kain et al., 2022).

An explanation of what a therapeutic relationship is in psychiatry

A therapeutic relationship refers to a collaborative partnership between the patient and healthcare provider in mental health care. According to Weinberg and Ronningstam (2022), the ability of a therapist to build a collaborative alliance with a patient is scheme to increase treatment effectiveness and  achieve treatment goal. Being attentive to the patient’s behaviors and inner experience and taking a nonjudgmental stance assist in treatment. Being attentive to the therapeutic relationship enables both the patient and therapist to negotiate contradictory perceptions, remain connected through affective tempests, and promote open-mindedness. Wheeler (2021) indicates that psychotherapy enhances healing happens through the connection that the patient has with the therapist.  Psychiatric nurses cultivate a relationship intended to alter patient’s interpersonal situation and the intrapsychic situation, thus altering the brain functioning.  The patient-nurse is the active component in therapeutic change.

I would share the NPD diagnosis with a patient by not using the diagnostic to avoid damaging the therapeutic relationship.  According to Hersh et al. (2019), sharing a diagnosis is essential in NPD to assist discussion of clinical features, etiology, treatment options, and course of illness.  Diagnostic sharing is the basis of informed consent to treatment (Hersh et al., 2019). Weinberg and Ronningstam (2022) emphasize that at the onset of treatment, it is essential explain diagnostic impressions to the patient.  Although some patients positively receive NPD disclosure on NPD diagnosis, others feel that NPD is a reprehensible label. As such, clinicians need to be flexible, and consider taking about the diagnosis without essentially utilizing the diagnostic label by referring to the patient as narcissist.  This will assist in describing treatment goals and behaviors that interfere with treatment,  and assists develop a longer commitment to treatment.

I would share the diagnosis with the individual in an individual session by providing the patient with useful information about NPD diagnosis and available treatments.  In a group and family session, I would discuss the diagnosis with the group members about NPD and provide education to group and family members about the disorder, behaviors that might interfere with treatment

Why sources are considered scholarly

The article by Choi-Kain et al. is peer-reviewed and authored by experts in psychiatry

The article by Hersh et al. is peer-reviewed and authored by experts in behavioral sciences

The article by Weinberg and Ronningstam is is peer-reviewed and authored by experts in psychiatry

The article by Szalay et al. is peer-reviewed and authored by experts in psychiatry

 

 

References

Choi-Kain, L. W., Simonsen, S., & Euler, S. (2022). A Mentalizing Approach for Narcissistic Personality Disorder: Moving From “Me-Mode” to “We-Mode.
American Journal of Psychotherapy, 75
(1), 38-43.
https://doi.org/10.1176/appi.psychotherapy.20210017

Hersh, R. G., McCommon, B., & Golkin, E. G. (2019). Sharing a Diagnosis of Narcissistic

Personality: a Challenging Decision with Associated Risks and Benefits. 
Current Behavioral Neuroscience Reports, 6
(16), 1-8.
https://doi.org/10.1007/s40473-019-00193-2

Szalay, Z., Hardaker, M., & Tsanikos, E. (2024). Narcissistic personality disorder: an opinionated review of the efficacy of psychotherapy.
Academia Mental Health & Well-Being, 1
, 1-8. https://doi.org/10.20935/MHealthWellB6239

Weinberg, I., & Ronningstam, E. (2022). Narcissistic Personality Disorder: Progress in Understanding and Treatment.
Focus, 20
(4), 368-377. doi:
10.1176/appi.focus.20220052

Wheeler, K. (2021). Psychotherapy for the Advanced Practice Psychiatric Nurse:  
A How-To Guide for Evidence-Based Practice
. Springer Publishing. Therapy for Clients With Personality Disorders