Handling suicidal crises in psychodynamic psychotherapy: A process case study

Journal of Clinical Psychology
Aline Alvares BittencourtFernanda Barcellos Serralta

Abstract

The core characteristics of patients with a borderline personality disorder (BPD) affect the therapeutic relationship and frequently lead psychodynamic therapists to adapt interventions to manage crises. This study aims to increase knowledge of how such crises affect the therapeutic process. Using her therapist's notes, combined with the Psychotherapy Process Q-Set, we studied the therapeutic process of the first 44 therapy sessions of a female BPD patient with many depressive-like symptoms, including a disruptive period that included hospitalization. We found marked differences between different phases of therapy (before a crisis, acute disorganization, hospitalization, and back to the consulting room). The analysis suggests that a crisis and hospitalization may occur without necessarily damaging the therapeutic process. The therapist's ability to tolerate aggression, to explore and contain suicide wishes and behaviors, and to flexibly adapt techniques to patient needs, are among the therapeutic attitudes and behaviors that can help restore an effective psychodynamic process.

References

Sep 4, 2007·Psychiatric Services : a Journal of the American Psychiatric Association·Juan C PascualAntonio Bulbena
Feb 12, 2010·World Psychiatry : Official Journal of the World Psychiatric Association (WPA)·Anthony Bateman, Peter Fonagy
Nov 9, 2010·Current Psychiatry Reports·Igor WeinbergJohn T Maltsberger
Jan 22, 2011·The International Journal of Social Psychiatry·Rohan Borschmann, Paul Moran
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Jun 12, 2012·Clinical Psychology Review·Kirsten BarnicotStefan Priebe
Mar 4, 2014·Psychiatric Services : a Journal of the American Psychiatric Association·Rohan BorschmannPaul Moran

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