RESUMO
Dissociative Identity Disorder (DID) is an under-researched entity and there are no clinical trials employing manual-based therapies and validated outcome measures. There is evidence that borderline personality disorder (BPD) commonly co-occurs with DID and can worsen its course. The authors report three cases of DID with co-occurring BPD that we successfully treated with a manual-based treatment, Dynamic Deconstructive Psychotherapy (DDP). Each of the three clients achieved a 34% to 79% reduction in their Dissociative Experiences Scale scores within 12 months of initiating therapy. Dynamic Deconstructive Psychotherapy was developed for treatment refractory BPD and differs in some respects from expert consensus treatment of DID. It may be a promising modality for DID complicated by co-occurring BPD.
Assuntos
Transtorno da Personalidade Borderline/complicações , Transtorno da Personalidade Borderline/terapia , Transtorno Dissociativo de Identidade/complicações , Transtorno Dissociativo de Identidade/terapia , Psicoterapia/métodos , Adulto , Transtorno da Personalidade Borderline/psicologia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Transtorno Dissociativo de Identidade/psicologia , Feminino , Seguimentos , Humanos , Hipnose/métodos , Narcisismo , Escalas de Graduação Psiquiátrica/estatística & dados numéricosRESUMO
Although a number of psychotherapeutic modalities for borderline personality disorder (BPD) have empirical support, it is unclear what aspects of treatment are responsible for improvement. The present study analyzes the relationships between different techniques and outcomes in a randomized controlled trial of dynamic deconstructive psychotherapy (DDP) for comorbid BPD and alcohol-use disorders. Video recordings of psychotherapy sessions at 3-month intervals were rated to measure therapeutic alliance and the relative frequencies of specific treatment interventions. Outcomes included measures of borderline symptoms, depression, dissociation, social support, alcohol misuse, parasuicide, and institutional care. Discrete sets of techniques were associated with reliable changes in specific outcomes, indicating that treatments for BPD should be tailored to the specific constellation of symptoms presenting in a given individual. The study findings suggest that treatments with a specified set of techniques, such as DDP, dialectical behavior therapy, mentalization-based treatment, schema therapy, supportive therapies, and transference-focused psychotherapy, may be helpful for different individuals, depending on their particular set of symptoms.
Assuntos
Transtorno da Personalidade Borderline/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Terapia Psicanalítica/métodos , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/psicologia , Comorbidade , Humanos , Relações Interpessoais , Teoria Psicanalítica , Psicopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Gravação em VídeoRESUMO
The final moments of a life pose a special and very important time for all participants. Sensitive arrangement of events can provide harmony and a peaceful and memorable transition event. A specific situation, in which a feather is used to symbolize the transition, is reported. Hospice programs can offer ecologically based celebration of life and provide a positive transition for patients, families, friends, and staff.