Cognitive-behavioral treatment of borderline personality disorder

For the average clinician, clinic, or inpatient facility, individuals with borderline personality disorder often represent the most difficult and insoluble cases. The first volume to provide strategies proven effective in controlled clinical trials, this book is a comprehensive, integrated approach to therapy with this population. Marsha Linehan presents specific guidelines that creatively combine the best elements of behavioral, psychoanalytic, strategic, and other commonly employed modalities. A clinical innovator, she has analyzed the aspects of borderline into their component parts and developed a systematized approach to each of them. The first section of the book presents an overview of the disorder and lays out a theoretical framework to guide the therapy. The second describes in detail how to assess borderline patients and how to organize and prioritize treatment goals and behavioral targets. The core of the treatment is the balance of acceptance and change strategies, both within each therapy interaction and over time. For problem solving with borderline personality disorder, the book provides specific strategies for contingency management, exposure, cognitive modification, and skills training. The last component is further elucidated in the companion Skills Training Manual, which programmatically details procedures and includes client handouts for step-by-step implementation. Finally, to enhance interpersonal communication, Dr. Linehan presents three case management sets: consultation to the patient, environmental intervention, and consultation to the therapist. Addressing the most stressful patient behaviors that clinicians encounter, the book includes a step-by-step outline for assessing suicide risk, managing suicide threats, and working with chronic suicidal behavior. Integrative approaches for such specific problems as crises, noncompliance, and breakdowns in the therapeutic relationship are also discussed. Lucidly detailing effective techniques that can be replicated in clinical practice, this volume illuminates the internal experience of borderline individuals and provides clinicians with practical clinical tools for working with them. As such, it is an invaluable resource for all professionals who work with this difficult-to-treat population.