Treatment considerations for health professionals

The complexity of a Borderline Personality Disorder (BPD) presentation lends it self to much confusion and conjecture within the mental health profession. As highlighted in the DSM5 and ICD10 diagnostic criteria, there are a number of mitigating circumstances which add to the complexity of treating and diagnosing an individual with a BPD presentation.  In addition to this, mental health professionals are at times confused by a lack of formal policy and direction for an evidence based approach to the therapeutic treatment of BPD.

Paris (2007, p.56) highlights an important issue that concerns health professionals for this client group ‘A day in day out obsession with suicide over many years in a non-psychotic patient immediately suggests this diagnosis’. As such health professionals often find themselves struggling to comprehend the chronicity of an individual’s thought pattern and risk. This confusion adds to the anxiety and perceived lack of an adequate response for individuals with BPD.

All too common is conjecture around treatment, seriousness of suicide risk and perceived failure of individuals with BPD to appear committed to treatment result in judgments by mental health professionals and society in general.  A number of studies cited in McGrath and Dowling (2012) examine these concerns by exploring the attitudes of nurses towards service users with BPD. These studies report the perception of individuals with BPD as being ‘powerful’, ‘difficult’, ‘dangerous’, ‘manipulative’, ‘demanding’, ‘attention seeking’, ‘destructive in their behaviours’, ‘split staff’ and display manipulative behaviours’ (McGrath & Dowling, 2012). Judgments like those identified in McGrath and Dowling (2012) contribute to the complexity of treatment needs for BPD resulting in an exacerbation of BPD features. Feelings of invalidation, judgment and abandonment then become the focus of the patient and progression towards effective outcomes seems near impossible to both the patient and mental health professional providing treatment.

Through expert training and supervision, health professionals have the potential to eliminated judgments and fears like those identified in McGrath and Dowling (2012). Lessening the fear of clinicians ultimately leads to best outcomes and an adequate response for individuals with BPD.

The Australian DBT Institute provides leadership to the mental health sector in the application of DBT and modified DBT programs for specific populations that include youth, Indigenous Australians, correctional settings and psychiatric emergency settings. The Australian DBT Institute gives consumers & carers the confidence that accredited DBT programs apply treatment in an evidence-based manner that emphasises clinical outcomes and results.

The Australian DBT Institute, established in 2004, provides a range of professional development opportunities for Mental Health Professionals seeking to become proficient in dialectical behaviour therapy-informed approaches. Our team is led by experienced DBT clinicians who have received training, mentoring, and development from Marsha Linehan’s team at Behavioral Tech LLC (2004-8). The Australian DBT Institute has led high-fidelity DBT programs since 2004 through the Essentia Health Clinics in Melbourne, Sydney and Online. Our clinical programs have included comprehensive DBT and modified DBT programs for specific populations including youth, carers, Indigenous Australians, correctional settings and psychiatric emergency settings.