Читать книгу Schema Therapy for Borderline Personality Disorder - Hannie van Genderen - Страница 39

Any disorder that needs immediate attention and that cannot be viewed as a consequence of BPD that will disappear with proper treatment of BPD, should first get attention, before a treatment of BPD is considered. This should already be clear from the diagnostic phase, as such disorders should be the primary disorder (thus, BPD a secondary disorder). There are a few disorders that specifically require attention before ST can begin. As described in the section on contraindications (Chapter 2), this involves a limited number of disorders. In all other cases, treatment of disorders other than BPD before ST can start may be omitted. It is possible that symptoms of such disorders will arise, or return, at a later stage of therapy. In that case, it might be necessary to return to a specialized treatment of these disorders, which can sometimes be done in parallel to ST, whereas in other cases ST has to be interrupted temporarily (e.g., in case of clinical detoxification). The treatment of these specific disorders is not discussed in this book as their treatment does not differ for patients without BPD and can be found adequately explained in other works.

As comorbidity is the rule, we don't recommend excluding patients from ST because of comorbidity. We have successfully treated patients with for instance seven comorbid disorders. What is recommended, is to integrate the comorbidity in the case conceptualization. In other words, the schema mode model should also explain how the comorbid disorders relate to the modes. By understanding what the function of the comorbid problems are, or how they result from the modes, the therapist can integrate them in the patient's mode model. The focus of ST is primarily on the modes, and not on symptoms or disorders. Only when a specific symptom or disorder doesn't change despite successfully addressing the mode that is associated with it, specific techniques (or medication) for these remaining problems should be considered.