Читать книгу Schema Therapy for Borderline Personality Disorder - Hannie van Genderen - Страница 41

Nora is a 25‐year‐old woman presented with anxiety, escalating quarrels with her boyfriend, self‐harm, mood swings, and depressive episodes. She is living by herself and has a limited social network with only one meaningful friend.

Her boyfriend has no regular work. He uses drugs and alcohol. Nora cleans people's homes about 24 hr a week.

Nora has a very low self‐image with doubts about her abilities. She didn't complete any higher education despite the fact that she is quite intelligent. Because of her insecurity she avoids social activities which makes her feel lonely and depressed. If she cannot avoid social contact, she behaves tougher than she is with the result that she gets exhausted.

Nora grew up in a family with two brothers and one sister. Her father was a dominant, aggressive man who drank too much out of insecurity. Without alcohol he was only verbally aggressive, but when he got drunk, he also became physically aggressive. Mother is a gentle, kind but also anxious and submissive woman. For fear of her husband she kept her mouth shut and didn't protect the children. After father's outbursts she always tried to hush up the abuse. Her statement was “Ah you know him” and “you better stay quiet because saying something will only make things worse.”

If it all became too much for mother, she would sometimes go to her family for a few days. That was very frightening for Nora because she never knew if and when mother would return. Mother could not handle the family and often called on Nora to help her.

Nora has always felt lonely and different in relation to peers. Her family was considered to be different and people were afraid of her father. She did well at school because she has an above‐average intelligence, but due to her problems at home she just managed to complete lower level education.

Diagnostically there is a recurrent depressive disorder in partial remission, a generalized social anxiety disorder, and a borderline personality disorder with dependent and avoidant features.

The initial phase of the therapy involves approximately five sessions during which a case conceptualization is made. The therapist uses three pathways to gather the information that is needed to make a comprehensive overview of the actual problems, the (origin of) the schemas and modes and the connection between these parts. That means that he tries to gather information via cognitive, behavioral, and experiential channels.

The different ways to gather information are:

 Cognitive:A diagnostic interview (information from former therapies)The downward arrow techniqueQuestionnaires

 Behavioral:Information from therapeutic relationshipBehavioral patterns reported by patient (and by referral and/or family members, if seen)

 Experiential:Imagery and two chair technique historical role play