Читать книгу Schema Therapy for Borderline Personality Disorder - Hannie van Genderen - Страница 45

In order to make the patient feel safe and understood from the very first session, the therapist takes a friendly, open, and not distanced position (see Chapter 4, “Limited Reparenting”). He spends a lot of time with the current problems of the patient and empathizes with her feelings. He examines, in conjunction with the patient, which situations trigger intense emotions. Further, he also looks at how she usually deals with her problems and in how far this is helpful in solving them. He informs himself about the patient's expectations toward the therapy and the therapist and asks for previous experiences with therapy. Often the patient has already had experience with a number of different therapies, which produced limited results or even a damaging effect, for instance broken trust (sometimes even sexual abuse) of the patient by the therapist. Therefore, the therapist must be aware that the patient might distrust him in advance. He explains how far the patient's expectations can be met in the therapy and what the general rules are (see discussion in Chapter 4).

The therapist is very attentive to the way the patient treats him. From the behavior of the patient he can gather information about the schemas, modes and the coping strategies of the patient.

The process of treating a BPD patient seldom begins with a calm conversation of information collection and case conceptualization. One should not be surprised when this process of information gathering is more of a rollercoaster as opposed to a quiet drive in the country. Often from day one it is clear that the patient is not comfortable or in a state to embark on a constructive relationship with the therapist. The development of a therapeutic relationship and the gathering of information will be discussed in the next chapter.